title: Warfarin and Antiplatelet Therapy Versus Warfarin Alone for Treating Patients With Atrial Fibrillation Undergoing Transcatheter Aortic Valve Replacement.
abstract: The study sought to examine the risk of ischemic events and bleeding episodes associated with differing antithrombotic strategies in patients undergoing transcatheter aortic valve replacement (TAVR) with concomitant atrial fibrillation (AF).
  
  
  
  Guidelines recommend antiplatelet therapy (APT) post-TAVR to reduce the risk of stroke. However, data on the efficacy and safety of this recommendation in the setting of a concomitant indication for oral anticoagulation (due to atrial fibrillation [AF]) with a vitamin K antagonist (VKA) are scarce.
  
  
  
  A multicenter evaluation comprising 621 patients with AF undergoing TAVR was undertaken. Post-TAVR prescriptions were used to determine the antithrombotic regimen used according to the following 2 groups: monotherapy (MT) with VKA (n = 101) or multiple antithrombotic therapy (MAT) with VKA plus 1 or 2 antiplatelet agents (aspirin or clopidogrel; n = 520). Endpoint definitions were in accordance with Valve Academic Research Consortium-2 criteria. The rate of stroke, major adverse cardiovascular events (stroke, myocardial infarction, or cardiovascular death), major or life-threatening bleeding events, and death were assessed by a Cox multivariate model regression survival analysis according to the antithrombotic regime used.
  
  
  
  During a median follow-up of 13 months (interquartile range: 3 to 31 months) there were no differences between groups in the rate of stroke (MT: 5%, MAT: 5.2%; adjusted hazard ratio [HR]: 1.25; 95% confidence interval [CI]: 0.45 to 3.48; p = 0.67), major adverse cardiovascular events (MT: 13.9%, MAT: 16.3%; adjusted HR: 1.33; 95% CI: 0.75 to 2.36; p = 0.33), and death (MT 22.8%, MAT: 19.2%; adjusted HR: 0.93; 95% CI: 0.58 to 1.50; p = 0.76). A higher risk of major or life-threatening bleeding was found in the MAT group (MT: 14.9%, MAT: 24.4%; adjusted HR: 1.85; 95% CI: 1.05 to 3.28; p = 0.04). These results remained similar when patients receiving VKA plus only 1 antiplatelet agent (n = 463) were evaluated.
  
  
  
  In TAVR recipients prescribed VKA therapy for AF, concomitant antiplatelet therapy use appears not to reduce the incidence of stroke, major adverse cardiovascular events, or death, while increasing the risk of major or life-threatening bleeding.
authors.affiliation: Cardiology Department, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors.forename: Omar
authors.initials: O
authors.lastname: Abdul-Jawad Altisent
authors.affiliation: Cardiology Department, University Hospital of Rouen, Hospital Charles Nicolle, Rouen, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Durand
authors.affiliation: Cardiology Department, Hospital Universitario Virgen de la Victoria, Universidad de Málaga, Málaga, Spain.
authors.forename: Antonio J
authors.initials: AJ
authors.lastname: Muñoz-García
authors.affiliation: Cardiology Department, Hospital Universitario Clínico San Carlos, Madrid, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Nombela-Franco
authors.affiliation: Cardiology Department, St. Michael's Hospital, Toronto University, Toronto, Ontario, Canada.
authors.forename: Asim
authors.initials: A
authors.lastname: Cheema
authors.affiliation: Cardiology Department, Saint Luc University Hospital, Brussels, Belgium.
authors.forename: Joelle
authors.initials: J
authors.lastname: Kefer
authors.affiliation: Cardiology Department, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
authors.forename: Enrique
authors.initials: E
authors.lastname: Gutierrez
authors.affiliation: Cardiology Department, Clìnica de Occidente de Cali, Valle del Cauca, Colombia.
authors.forename: Luis M
authors.initials: LM
authors.lastname: Benítez
authors.affiliation: Cardiology Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.
authors.forename: Ignacio J
authors.initials: IJ
authors.lastname: Amat-Santos
authors.affiliation: Cardiology Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Vicenç
authors.initials: V
authors.lastname: Serra
authors.affiliation: Cardiology Department, University Hospital of Rouen, Hospital Charles Nicolle, Rouen, France.
authors.forename: Helene
authors.initials: H
authors.lastname: Eltchaninoff
authors.affiliation: Cardiology Department, St. Michael's Hospital, Toronto University, Toronto, Ontario, Canada.
authors.forename: Sami M
authors.initials: SM
authors.lastname: Alnasser
authors.affiliation: Cardiology Department, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
authors.forename: Jaime
authors.initials: J
authors.lastname: Elízaga
authors.affiliation: Cardiology Department, Clìnica de Occidente de Cali, Valle del Cauca, Colombia.
authors.forename: Antonio
authors.initials: A
authors.lastname: Dager
authors.affiliation: Cardiology Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Bruno
authors.initials: B
authors.lastname: García Del Blanco
authors.affiliation: Cardiology Department, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors.forename: Maria Del Rosario
authors.initials: Mdel R
authors.lastname: Ortas-Nadal
authors.affiliation: Cardiology Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain.
authors.forename: Josep Ramon
authors.initials: JR
authors.lastname: Marsal
authors.affiliation: Cardiology Department, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors.forename: Francisco
authors.initials: F
authors.lastname: Campelo-Parada
authors.affiliation: Cardiology Department, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors.forename: Ander
authors.initials: A
authors.lastname: Regueiro
authors.affiliation: Cardiology Department, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors.forename: Maria
authors.initials: M
authors.lastname: Del Trigo
authors.affiliation: Cardiology Department, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors.forename: Eric
authors.initials: E
authors.lastname: Dumont
authors.affiliation: Cardiology Department, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors.forename: Rishi
authors.initials: R
authors.lastname: Puri
authors.affiliation: Cardiology Department, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada. Electronic address: josep.rodes@criucpq.ulaval.ca.
authors.forename: Josep
authors.initials: J
authors.lastname: Rodés-Cabau
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D001021:Aortic Valve / Q000601:surgery*; D001281:Atrial Fibrillation / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D002545:Brain Ischemia / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D002170:Canada; D016009:Chi-Square Distribution; D005060:Europe; D005260:Female; D006349:Heart Valve Diseases / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D015999:Multivariate Analysis; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D016016:Proportional Hazards Models; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D013997:Time Factors; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects / Q000401:mortality; D016896:Treatment Outcome; D014812:Vitamin K / Q000037:antagonists & inhibitors / Q000097:blood; D014859:Warfarin / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D014812:Vitamin K; D014859:Warfarin
keywords: bleeding; stroke; transcatheter aortic valve replacement; warfarin