Ioanna Kosmidou1, Yangbo Liu2, Maria C Alu3, Mengdan Liu2, Mahesh Madhavan4, Tarun Chakravarty5, Raj Makkar5, Vinod H Thourani6, Angelo Biviano3, Susheel Kodali4, Martin B Leon4. 1. Clinical Trials Center, Cardiovascular Research Foundation, New York, New York; Department of Medicine, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, New York. Electronic address: ik2394@cumc.columbia.edu. 2. Clinical Trials Center, Cardiovascular Research Foundation, New York, New York. 3. Department of Medicine, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, New York. 4. Clinical Trials Center, Cardiovascular Research Foundation, New York, New York; Department of Medicine, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, New York. 5. Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California. 6. Department of Cardiac Surgery, Medstar Heart and Vascular Institute/Georgetown University, Washington, DC.
Abstract
OBJECTIVES: The study sought to determine the patterns of antithrombotic therapy and association with clinical outcomes in patients with atrial fibrillation (AF) and CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, prior stroke or transient ischemic attack or thromboembolism, vascular disease, age 65-74 years, sex category) score ≥2 following transcatheter aortic valve replacement (TAVR). BACKGROUND: The impact of antithrombotic regimens on clinical outcomes in patients with AF and severe aortic stenosis treated with TAVR is unknown. METHODS: In the randomized PARTNER II (Placement of Aortic Transcatheter Valve II) trial and associated registries, 1,621 patients with prior AF and CHA2DS2-VASc score ≥2 comprised the study cohort. Outcomes were analyzed according to antithrombotic therapy. RESULTS: During the 5-year enrollment period, 933 (57.6%) patients were discharged on oral anticoagulant therapy (OAC). Uninterrupted antiplatelet therapy (APT) for at least 6 months or until an endpoint event was used in 544 of 933 (58.3%) of patients on OAC and 77.5% of patients not on OAC. At 2 years, patients on OAC had a similar rate of stroke (6.6% vs. 5.6%; p = 0.53) and the composite outcome of death or stroke (29.7% vs. 31.8%; p = 0.33), compared with no OAC. OAC with APT was associated with a reduced rate of stroke (5.4% vs. 11.1%; p = 0.03) and death or stroke (29.7% vs. 40.1%; p = 0.01), compared with no OAC or APT. Following adjustment, OAC with APT and APT alone were both associated with reduced rates of stroke compared with no OAC or APT (hazard ratio for OAC+APT: 0.43, 95% confidence interval: 0.22 to 0.85; p = 0.015; hazard ratio for APT alone: 0.32, 95% confidence interval: 0.16 to 0.65; p = 0.002), while OAC alone was not. CONCLUSIONS: Among patients with prior AF undergoing TAVR, antiplatelet with or without anticoagulant therapy was associated with a reduced risk of stroke at 2 years, implicating multifactorial stroke mechanisms in this population.
OBJECTIVES: The study sought to determine the patterns of antithrombotic therapy and association with clinical outcomes in patients with atrial fibrillation (AF) and CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, prior stroke or transient ischemic attack or thromboembolism, vascular disease, age 65-74 years, sex category) score ≥2 following transcatheter aortic valve replacement (TAVR). BACKGROUND: The impact of antithrombotic regimens on clinical outcomes in patients with AF and severe aortic stenosis treated with TAVR is unknown. METHODS: In the randomized PARTNER II (Placement of Aortic Transcatheter Valve II) trial and associated registries, 1,621 patients with prior AF and CHA2DS2-VASc score ≥2 comprised the study cohort. Outcomes were analyzed according to antithrombotic therapy. RESULTS: During the 5-year enrollment period, 933 (57.6%) patients were discharged on oral anticoagulant therapy (OAC). Uninterrupted antiplatelet therapy (APT) for at least 6 months or until an endpoint event was used in 544 of 933 (58.3%) of patients on OAC and 77.5% of patients not on OAC. At 2 years, patients on OAC had a similar rate of stroke (6.6% vs. 5.6%; p = 0.53) and the composite outcome of death or stroke (29.7% vs. 31.8%; p = 0.33), compared with no OAC. OAC with APT was associated with a reduced rate of stroke (5.4% vs. 11.1%; p = 0.03) and death or stroke (29.7% vs. 40.1%; p = 0.01), compared with no OAC or APT. Following adjustment, OAC with APT and APT alone were both associated with reduced rates of stroke compared with no OAC or APT (hazard ratio for OAC+APT: 0.43, 95% confidence interval: 0.22 to 0.85; p = 0.015; hazard ratio for APT alone: 0.32, 95% confidence interval: 0.16 to 0.65; p = 0.002), while OAC alone was not. CONCLUSIONS: Among patients with prior AF undergoing TAVR, antiplatelet with or without anticoagulant therapy was associated with a reduced risk of stroke at 2 years, implicating multifactorial stroke mechanisms in this population.
Authors: Amanda Jia Qi Ooi; Chloe Wong; Timothy Wei Ern Tan; Trina Priscilla Ng; Yao Neng Teo; Yao Hao Teo; Nicholas L Syn; Andie H Djohan; Yinghao Lim; Leonard L L Yeo; Benjamin Y Q Tan; Mark Yan-Yee Chan; Kian-Keong Poh; William K F Kong; Ping Chai; Tiong-Cheng Yeo; James W Yip; Ivandito Kuntjoro; Ching-Hui Sia Journal: Eur J Clin Pharmacol Date: 2022-08-09 Impact factor: 3.064
Authors: Matthew W Sherwood; Aakriti Gupta; Sreekanth Vemulapalli; Zhuokai Li; Jonathan Piccini; J Kevin Harrison; David Dai; Amit N Vora; Michael J Mack; David R Holmes; John S Rumsfeld; David J Cohen; Vinod H Thourani; Ajay J Kirtane; Eric D Peterson Journal: Circ Cardiovasc Interv Date: 2021-04-20 Impact factor: 6.546