Katarzyna Czerwińska-Jelonkiewicz1, Marian Zembala2, Maciej Dąbrowski3, Adam Witkowski3, Andrzej Ochała4, Janusz Kochman5, Dariusz Dudek6, Piotr Kübler7, Dariusz Jagielak8, Janina Stępińska9. 1. Intensive Cardiac Therapy Department, Institute of Cardiology, Warsaw, Poland. Electronic address: kasia_czerwinska@vp.pl. 2. Department of Cardiac Surgery and Transplantology, Silesian Center for Heart Diseases, Zabrze, Poland. 3. Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland. 4. 7th Public Hospital of the Silesian Medical University, Katowice, Poland. 5. 1(st) Department of Cardiology, Medical University of Warsaw, Poland. 6. Jagiellonian University Medical College, Krakow, Poland. 7. Medical University, Military Hospital, Wroclaw, Poland. 8. Department of Cardiac and Vascular Surgery, Medical University, Gdańsk, Poland. 9. Intensive Cardiac Therapy Department, Institute of Cardiology, Warsaw, Poland.
Abstract
BACKGROUND: This observational analysis investigated in-hospital safety and efficacy of periprocedural antithrombotic/antiplatelet therapy used in TAVI patients included into the Polish Nationwide Cardiac Surgical and Cardiology Registry of Transcatheter Aortic Valve Implantation (POL-TAVI). METHODS AND RESULTS: All patients who underwent TAVI in the participating centers between 2013 and 2014 were included. The primary endpoints were: severe bleeding, vascular complications, thromboembolic events, myocardial infarction, 30-days mortality, defined according to Valve Academic Research Consortium scale 2. A total of 827 patients were included; 35-93years old (79.31±7.53); 457 (55.29%) women. Endpoints noted: severe bleeding - 130 (15.72%) pts, vascular complications - 135 (16.32%) pts, thromboembolic events - 29 (3.5%) pts, myocardial infarction - 24 (2.90%) pts, deaths - 58 (7.01%) pts. Aspirin premedication, resulted in the least number of vascular complications (OR 0.56 95%CI [0.345-0.938]; p=0.027). Aspirin after TAVI reduced the risk of vascular complications (OR 0.089 95%CI [0.0217-0.372]; p=0.001) and bleeding (OR 0.138 95%CI [0.043-0.447]; p=0.001) with no adverse impact on efficacy endpoints. Beneficial safety profile of postprocedural aspirin monotherapy remained significant in comparison to all other types of prophylaxis also in propensity score analysis: OR 0.068 95%CI [0.009-0.529]; p=0.01 for vascular complications, OR 0.176 95%CI [0.049-0.627]; p=0.007 for bleeding. NNT for vascular complications and bleeding with postprocedural aspirin prophylaxis was 5.5 and 6.42, respectively. CONCLUSION: Aspirin after TAVI appears to be beneficial than currently recommended dual antiplatelet therapy; therefore, it might be considered as TAVI antithrombotic prophylaxis.
BACKGROUND: This observational analysis investigated in-hospital safety and efficacy of periprocedural antithrombotic/antiplatelet therapy used in TAVI patients included into the Polish Nationwide Cardiac Surgical and Cardiology Registry of Transcatheter Aortic Valve Implantation (POL-TAVI). METHODS AND RESULTS: All patients who underwent TAVI in the participating centers between 2013 and 2014 were included. The primary endpoints were: severe bleeding, vascular complications, thromboembolic events, myocardial infarction, 30-days mortality, defined according to Valve Academic Research Consortium scale 2. A total of 827 patients were included; 35-93years old (79.31±7.53); 457 (55.29%) women. Endpoints noted: severe bleeding - 130 (15.72%) pts, vascular complications - 135 (16.32%) pts, thromboembolic events - 29 (3.5%) pts, myocardial infarction - 24 (2.90%) pts, deaths - 58 (7.01%) pts. Aspirin premedication, resulted in the least number of vascular complications (OR 0.56 95%CI [0.345-0.938]; p=0.027). Aspirin after TAVI reduced the risk of vascular complications (OR 0.089 95%CI [0.0217-0.372]; p=0.001) and bleeding (OR 0.138 95%CI [0.043-0.447]; p=0.001) with no adverse impact on efficacy endpoints. Beneficial safety profile of postprocedural aspirin monotherapy remained significant in comparison to all other types of prophylaxis also in propensity score analysis: OR 0.068 95%CI [0.009-0.529]; p=0.01 for vascular complications, OR 0.176 95%CI [0.049-0.627]; p=0.007 for bleeding. NNT for vascular complications and bleeding with postprocedural aspirin prophylaxis was 5.5 and 6.42, respectively. CONCLUSION:Aspirin after TAVI appears to be beneficial than currently recommended dual antiplatelet therapy; therefore, it might be considered as TAVI antithrombotic prophylaxis.
Authors: Joanna Zembala-John; Krzysztof Wilczek; Zdzisław Tobota; Piotr Chodór; Daniel Cieśla; Tomasz Jaźwiec; Waldemar Banasiak; Janina Stępińska; Zbigniew Kalarus; Grzegorz Opolski; Marian Zembala Journal: Kardiochir Torakochirurgia Pol Date: 2016-12-30
Authors: Katarzyna Czerwińska-Jelonkiewicz; Krzysztof Milewski; Piotr Buszman; Przemysław Kwasiborski; Krzysztof Sanetra; Wojciech Domaradzki; Paweł Buszman Journal: Postepy Kardiol Interwencyjnej Date: 2019-03-15 Impact factor: 1.426