title: Comparison of two antiplatelet therapy strategies in patients undergoing transcatheter aortic valve implantation.
abstract: Dual antiplatelet therapy is commonly used in patients undergoing transcatheter aortic valve implantation (TAVI), but the optimal antiplatelet regimen is uncertain and remains to be determined. The objective of this study was to compare 2 strategies of antiplatelet therapy in patients undergoing TAVI. A strategy using monoantiplatelet therapy (group A, n = 164) was prospectively compared with a strategy using dual antiplatelet therapy (group B, n = 128) in 292 consecutive patients undergoing TAVI. The primary end point was a combination of mortality, major stroke, life-threatening bleeding (LTB), myocardial infarction, and major vascular complications at 30 days. All adverse events were adjudicated according to the Valve Academic Research Consortium. The primary end point occurred in 22 patients (13.4%) in the group A and in 30 patients (23.4%) in the group B (hazard ratio 0.51, 95% confidence interval 0.28 to 0.94, p = 0.026). LTB (3.7% vs 12.5%, p = 0.005) and major bleedings (2.4% vs 13.3%, p <0.0001) occurred less frequently in the group A, whereas the incidence of stroke (1.2% vs 4.7%, p = 0.14) and myocardial infarction (1.2% vs 0.8%, p = 1.0) was not significantly different between the 2 groups. The benefit of a strategy using mono versus dual antiplatelet therapy persisted after multivariate adjustment and propensity score analysis (hazard ratio 0.53, 95% confidence interval 0.28 to 0.95, p = 0.033). In conclusion, a strategy using mono versus dual antiplatelet therapy in patients undergoing TAVI reduces LTB and major bleedings without increasing the risk of stroke and myocardial infarction. The results of our study question the justification of dual antiplatelet therapy and require confirmation in a randomized trial.
authors.affiliation: University Paris-Descartes; AP-HP; European Georges Pompidou Hospital, Departments of Cardiology and Cardiac Surgery, Paris, France; University Hospital of Rouen, Hospital Charles Nicolle, Departments of Cardiology and Thoracic and Cardiovascular Surgery, INSERM UMR 1096, Rouen, France. Electronic address: eric.durand@egp.aphp.fr.
authors.forename: Eric
authors.initials: E
authors.lastname: Durand
authors.affiliation: University Paris-Descartes; AP-HP; European Georges Pompidou Hospital, Departments of Cardiology and Cardiac Surgery, Paris, France; Clinique Saint Gatien, Departments of Cardiology and Cardiac Surgery, Tours, France.
authors.forename: Didier
authors.initials: D
authors.lastname: Blanchard
authors.affiliation: Clinique Saint Gatien, Departments of Cardiology and Cardiac Surgery, Tours, France.
authors.forename: Stephan
authors.initials: S
authors.lastname: Chassaing
authors.affiliation: Université de Bretagne Occidentale, Department of Cardiology, CHU de la Cavale Blanche, EA 4524, Brest, France.
authors.forename: Martine
authors.initials: M
authors.lastname: Gilard
authors.affiliation: University Hospital Dupuytren, Department of cardiac Surgery, Limoges, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Laskar
authors.affiliation: University Hospital of Rouen, Hospital Charles Nicolle, Departments of Cardiology and Thoracic and Cardiovascular Surgery, INSERM UMR 1096, Rouen, France.
authors.forename: Bogdan
authors.initials: B
authors.lastname: Borz
authors.affiliation: University Paris-Descartes; AP-HP; European Georges Pompidou Hospital, Departments of Cardiology and Cardiac Surgery, Paris, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Lafont
authors.affiliation: Clinique Saint Gatien, Departments of Cardiology and Cardiac Surgery, Tours, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Barbey
authors.affiliation: University Hospital of Rouen, Hospital Charles Nicolle, Departments of Cardiology and Thoracic and Cardiovascular Surgery, INSERM UMR 1096, Rouen, France.
authors.forename: Matthieu
authors.initials: M
authors.lastname: Godin
authors.affiliation: University Hospital of Rouen, Hospital Charles Nicolle, Departments of Cardiology and Thoracic and Cardiovascular Surgery, INSERM UMR 1096, Rouen, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Tron
authors.affiliation: University Paris-Descartes; AP-HP; European Georges Pompidou Hospital, Departments of Cardiology and Cardiac Surgery, Paris, France.
authors.forename: Rachid
authors.initials: R
authors.lastname: Zegdi
authors.affiliation: Clinique Saint Gatien, Departments of Cardiology and Cardiac Surgery, Tours, France.
authors.forename: Didier
authors.initials: D
authors.lastname: Chatel
authors.affiliation: Clinique Saint Gatien, Departments of Cardiology and Cardiac Surgery, Tours, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Le Page
authors.affiliation: University Hospital of Rouen, Hospital Charles Nicolle, Departments of Cardiology and Thoracic and Cardiovascular Surgery, INSERM UMR 1096, Rouen, France.
authors.forename: Pierre-Yves
authors.initials: PY
authors.lastname: Litzler
authors.affiliation: University Hospital of Rouen, Hospital Charles Nicolle, Departments of Cardiology and Thoracic and Cardiovascular Surgery, INSERM UMR 1096, Rouen, France.
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Bessou
authors.affiliation: University Paris-Descartes; AP-HP; European Georges Pompidou Hospital, Departments of Cardiology and Cardiac Surgery, Paris, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Danchin
authors.affiliation: University Hospital of Rouen, Hospital Charles Nicolle, Departments of Cardiology and Thoracic and Cardiovascular Surgery, INSERM UMR 1096, Rouen, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Cribier
authors.affiliation: University Hospital of Rouen, Hospital Charles Nicolle, Departments of Cardiology and Thoracic and Cardiovascular Surgery, INSERM UMR 1096, Rouen, France.
authors.forename: Hélène
authors.initials: H
authors.lastname: Eltchaninoff
mesh_terms: D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000628:therapy*; D006328:Cardiac Catheterization / Q000592:standards*; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D019918:Heart Valve Prosthesis Implantation / Q000379:methods / Q000592:standards*; D006801:Humans; D015994:Incidence; D008297:Male; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D011183:Postoperative Complications; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D020521:Stroke / Q000453:epidemiology / Q000517:prevention & control*; D015996:Survival Rate / Q000639:trends
chemical_list: D010975:Platelet Aggregation Inhibitors