title: Antithrombotic therapy in patients undergoing TAVI with concurrent atrial fibrillation. One center experience.
abstract: Aim of the present study was to record the antithrombotic approach in AF and non-AF patients undergoing TAVI, and to compare the efficiency of the used regimens combination. Antithrombotic approach of patients undergoing TAVI remains a challenging dispute. It becomes even more complex when need for anticoagulant treatment is required due to concurrent atrial fibrillation. Consecutive patients with severe symptomatic aortic stenosis treated with TAVI, were retrospectively studied. All patients were divided into two groups, matched to age, depending on the existence of atrial fibrillation. The primary end-point was the composite of MACE, while the secondary end-point was the occurrence of major bleeding at follow-up. A total of 80 patients were included in the study. Out of them, 20 patients (80.2 ± 5.4 years) suffered from concurrent atrial fibrillation. This group was matched with 20 patients (80.6 ± 3.7 years) with no need for anticoagulation. AF-group patients were treated with clopidogrel plus acenocoumarol for 3 months. Following that, acetylsalicylic acid plus acenocoumarol were prescribed. Non-AF patients were treated with 3 months clopidogrel plus acetylsalicylic acid followed by single acetylsalicylic acid medication. No statistical significant differences in MACE between AF and non-AF group were identified (p = 0.705, phi coefficient = 0.06) (mean follow-up 23.4 ± 14 months). Similarly, there was no statistical significant difference for bleedings among the AF and non-AF patient group (p = 0.658, phi coefficient = 0.14). In patients undergoing TAVI with CoreValve, with concurrent AF, treatment with clopidogrel plus acenocoumarol for 3 months, followed by acetylsalicylic acid plus acenocoumarol, seems safe and effective enough in long-term follow-up.
authors: 1st Department of Cardiology, Hippokration Hospital, University of Athens, 13 Astypaleas, Anoixi, 14569, Attiki, Athens, Greece, vavouran@otenet.gr.
authors: Manolis
authors: M
authors: Vavuranakis
authors: Konstantinos
authors: K
authors: Kalogeras
authors: Dimitrios
authors: D
authors: Vrachatis
authors: Maria
authors: M
authors: Kariori
authors: Carmen
authors: C
authors: Moldovan
authors: Evelina
authors: E
authors: Mpei
authors: Maria
authors: M
authors: Lavda
authors: Angelos-Michail
authors: AM
authors: Kolokathis
authors: Gerasimos
authors: G
authors: Siasos
authors: Dimitrios
authors: D
authors: Tousoulis
mesh_terms: D000074:Acenocoumarol / Q000008:administration & dosage* / Q000009:adverse effects; D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000628:therapy*; D001281:Atrial Fibrillation / Q000628:therapy*; D000077144:Clopidogrel; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D013988:Ticlopidine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D065467:Transcatheter Aortic Valve Replacement
chemical_list: D005343:Fibrinolytic Agents; D000077144:Clopidogrel; D000074:Acenocoumarol; D013988:Ticlopidine