title: Dual antiplatelet therapy versus aspirin alone in patients undergoing transcatheter aortic valve implantation.
abstract: Dual antiplatelet therapy (DAPT) with clopidogrel and aspirin is a widely accepted strategy in patients undergoing transcatheter aortic valve implantation (TAVI), but this approach is not evidence based. The goal of the present study was to determine whether DAPT in patients undergoing TAVI is associated with improved outcomes compared to aspirin alone. From May 2009 to August 2010, consecutive patients were randomized to receive a 300-mg loading dose of clopidogrel on the day before TAVI followed by a 3-month maintenance daily dose of 75 mg plus aspirin 100 mg lifelong (DAPT group) or aspirin 100 mg alone (ASA group). The primary end point was the composite of major adverse cardiac and cerebrovascular events, defined as death from any cause, myocardial infarction, major stroke, urgent or emergency conversion to surgery, or life-threatening bleeding. The cumulative incidence of major adverse cardiac and cerebrovascular events at 30 days and 6 months was 14% and 16%, respectively. No significant differences between the DAPT and ASA groups were noted at both 30 days (13% vs 15%, p = 0.71) and 6 months (18% vs 15%; p = 0.85). In conclusion, the strategy of adding clopidogrel to aspirin for 3 months after TAVI was not found to be superior to aspirin alone. These results must be confirmed in a larger randomized trial.
authors: Division of Cardiology, Ferrarotto Hospital, University of Catania, Italy. gpussia@hotmail.com
authors: Gian Paolo
authors: GP
authors: Ussia
authors: Marilena
authors: M
authors: Scarabelli
authors: Massimiliano
authors: M
authors: Mulè
authors: Marco
authors: M
authors: Barbanti
authors: Kunal
authors: K
authors: Sarkar
authors: Valeria
authors: V
authors: Cammalleri
authors: Sebastiano
authors: S
authors: Immè
authors: Patrizia
authors: P
authors: Aruta
authors: Anna Maria
authors: AM
authors: Pistritto
authors: Simona
authors: S
authors: Gulino
authors: Wanda
authors: W
authors: Deste
authors: Davide
authors: D
authors: Capodanno
authors: Corrado
authors: C
authors: Tamburino
mesh_terms: D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000601:surgery*; D001241:Aspirin / Q000008:administration & dosage*; D057785:Catheters; D000077144:Clopidogrel; D004359:Drug Therapy, Combination; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D012720:Severity of Illness Index; D016037:Single-Blind Method; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives*
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin