title: Pre-procedural dual antiplatelet therapy and bleeding events following transcatheter aortic valve implantation (TAVI).
abstract: BACKGROUND
  Transcatheter aortic valve implantation (TAVI) is associated with bleeding that increases mortality. Dual antiplatelet therapy (DAPT) is recommended in TAVI, however little is known about pre-procedural DAPT use and its impact on hemostasis. We sought to determine the frequency, predictors and bleeding events in patients receiving DAPT before TAVI.
  
  
  METHODS
  Three-hundred-and-three (n=303, 78.6±7.6years, 49% female, EuroScore 23.1±16.9) consecutive patients undergoing TAVI were prospectively analyzed and followed for in-hospital events. According to pre-procedural antiplatelet status study population was divided into 2 groups: patients receiving aspirin and clopidogrel (DAPT) and those on aspirin only or no antiplatelet therapy (noDAPT).
  
  
  RESULTS
  Pre-procedural DAPT was used in 139 cases (46%). Previous PCI (OR 4.8, [2.8-8.3], p<0.0001), implantation of self-expandable prosthesis (OR 2.2, [1.2-4], p=0.007) femoral access (OR 2.2, [1.1-4.5], p=0.029) and platelet count (OR 1.006, [1.002-1.01], p=0.002) were identified as independent predictors of pre-procedural DAPT. No difference was observed in the rates of any bleeding (23% in DAPT vs. 24.4% in noDAPT, p=0.930) or major/life-threatening bleeding (12.2% in DAPT vs. 14.7% in noDAPT, p=0.715). Propensity-score matching analysis did not alter the results. GFR <30ml/min was the strongest predictor of bleeding (OR 4.3, [1.9-9.9], p=0.0005). There was a trend towards lower frequency of MI and stroke/TIA in DAPT as compared with noDAPT (3.6% vs. 9.8%, p=0.082).
  
  
  CONCLUSIONS
  Pre-procedural DAPT is frequent and does not increase short-term bleeding complications or need for transfusion following TAVI. Possible impact of DAPT use before TAVI on ischemic complications needs to be investigated in larger populations.
authors.affiliation: Ist Department of Cardiology, Medical University of Warsaw, Poland. Electronic address: zhuczek@wp.pl.
authors.forename: Zenon
authors.initials: Z
authors.lastname: Huczek
authors.affiliation: Ist Department of Cardiology, Medical University of Warsaw, Poland.
authors.forename: Janusz
authors.initials: J
authors.lastname: Kochman
authors.affiliation: Ist Department of Cardiology, Medical University of Poznan, Poland.
authors.forename: Marek
authors.initials: M
authors.lastname: Grygier
authors.affiliation: IIIrd Department of Cardiology, Silesian Medical University, Poland.
authors.forename: Radoslaw
authors.initials: R
authors.lastname: Parma
authors.affiliation: Ist Department of Cardiology, Medical University of Warsaw, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Scislo
authors.affiliation: Department of Cardiosurgery, Medical University of Warsaw, Poland.
authors.forename: Radoslaw
authors.initials: R
authors.lastname: Wilimski
authors.affiliation: IIIrd Department of Cardiology, Silesian Medical University, Poland.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Ochala
authors.affiliation: Ist Department of Cardiology, Medical University of Poznan, Poland.
authors.forename: Maciej
authors.initials: M
authors.lastname: Lesiak
authors.affiliation: Ist Department of Cardiology, Medical University of Poznan, Poland.
authors.forename: Anna
authors.initials: A
authors.lastname: Olasinska-Wisniewska
authors.affiliation: Ist Department of Cardiology, Medical University of Warsaw, Poland.
authors.forename: Marcin
authors.initials: M
authors.lastname: Grabowski
authors.affiliation: Ist Department of Cardiology, Medical University of Warsaw, Poland.
authors.forename: Tomasz
authors.initials: T
authors.lastname: Mazurek
authors.affiliation: Medical Department, Ludwig Maximilians University, Munich, Germany.
authors.forename: Dirk
authors.initials: D
authors.lastname: Sibbing
authors.affiliation: Ist Department of Cardiology, Medical University of Warsaw, Poland.
authors.forename: Krzysztof J
authors.initials: KJ
authors.lastname: Filipiak
authors.affiliation: Ist Department of Cardiology, Medical University of Warsaw, Poland.
authors.forename: Grzegorz
authors.initials: G
authors.lastname: Opolski
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001241:Aspirin / Q000009:adverse effects / Q000627:therapeutic use*; D000077144:Clopidogrel; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced*; D006801:Humans; D008297:Male; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D011446:Prospective Studies; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects / Q000379:methods*
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin