Document Detail


Considerations in antithrombotic therapy among patients undergoing transcatheter aortic valve implantation.
MedLine Citation:
PMID:  23420510     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Aortic stenosis (AS) accounts for the majority of valvular abnormalities requiring surgical intervention. Platelet dysfunction has been demonstrated among patients with severe aortic stenosis which may predispose patients to bleeding or ischemic events. Surgical aortic valve replacement (AVR) is the standard therapy for severe symptomatic AS; however, a number of patients have very high or prohibitive surgical risk. Transcatheter aortic valve implantation (TAVI) has been shown to be superior to medical therapy among inoperable patients and non-inferior to AVR in patients with high surgical risk. In comparison to AVR, TAVI has been associated with a higher incidence of ischemic cerebrovascular events, conduction abnormalities necessitating permanent pacemaker placement, and vascular complications. Current practice guidelines recommend dual antiplatelet therapy (DAPT) following TAVI using a combination of low dose aspirin and clopidogrel for 3-6 months. This regimen may be adjusted in patients with clinical bleeding events or indications for concomitant systemic anticoagulation. Recent and ongoing trials aim to clarify the optimum antithrombotic regimen and duration of therapy following TAVI. Collectively, early studies have not revealed additional benefit of adding clopidogrel to aspirin therapy in regards to reducing ischemic events, but have shown a trend towards increase in major bleeding. TAVI has proven successful, and as its breadth of utility is expanded, further studies are needed to define optimum antithrombotic therapy following TAVI. This article will review the current data for antiplatelet and anticoagulant therapy following TAVI.
Authors:
Donald R Lynch; David Dantzler; Mark Robbins; David Zhao
Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Journal of thrombosis and thrombolysis     Volume:  35     ISSN:  1573-742X     ISO Abbreviation:  J. Thromb. Thrombolysis     Publication Date:  2013 May 
Date Detail:
Created Date:  2013-05-17     Completed Date:  2013-12-13     Revised Date:  2014-03-06    
Medline Journal Info:
Nlm Unique ID:  9502018     Medline TA:  J Thromb Thrombolysis     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  476-82     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Aortic Valve Stenosis / therapy*
Aspirin / therapeutic use*
Cardiac Catheterization* / adverse effects,  instrumentation,  methods
Fibrinolytic Agents / therapeutic use*
Heart Valve Prosthesis*
Humans
Myocardial Ischemia / drug therapy,  etiology
Platelet Aggregation Inhibitors / therapeutic use*
Postoperative Complications / drug therapy,  etiology
Practice Guidelines as Topic
Ticlopidine / analogs & derivatives*,  therapeutic use
Time Factors
Grant Support
ID/Acronym/Agency:
T32 HL007411/HL/NHLBI NIH HHS
Chemical
Reg. No./Substance:
0/Fibrinolytic Agents; 0/Platelet Aggregation Inhibitors; A74586SNO7/clopidogrel; OM90ZUW7M1/Ticlopidine; R16CO5Y76E/Aspirin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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