title: Can TAVI patients receive aspirin monotherapy as patients after surgical aortic bioprosthesis implantation? Data from the Polish Registry - POL-TAVI.
abstract: BACKGROUND
  This observational analysis investigated in-hospital safety and efficacy of periprocedural antithrombotic/antiplatelet therapy used in TAVI patients included into the Polish Nationwide Cardiac Surgical and Cardiology Registry of Transcatheter Aortic Valve Implantation (POL-TAVI).
  
  
  RESULTS
  All patients who underwent TAVI in the participating centers between 2013 and 2014 were included. The primary endpoints were: severe bleeding, vascular complications, thromboembolic events, myocardial infarction, 30-days mortality, defined according to Valve Academic Research Consortium scale 2. A total of 827 patients were included; 35-93years old (79.31±7.53); 457 (55.29%) women. Endpoints noted: severe bleeding - 130 (15.72%) pts, vascular complications - 135 (16.32%) pts, thromboembolic events - 29 (3.5%) pts, myocardial infarction - 24 (2.90%) pts, deaths - 58 (7.01%) pts. Aspirin premedication, resulted in the least number of vascular complications (OR 0.56 95%CI [0.345-0.938]; p=0.027). Aspirin after TAVI reduced the risk of vascular complications (OR 0.089 95%CI [0.0217-0.372]; p=0.001) and bleeding (OR 0.138 95%CI [0.043-0.447]; p=0.001) with no adverse impact on efficacy endpoints. Beneficial safety profile of postprocedural aspirin monotherapy remained significant in comparison to all other types of prophylaxis also in propensity score analysis: OR 0.068 95%CI [0.009-0.529]; p=0.01 for vascular complications, OR 0.176 95%CI [0.049-0.627]; p=0.007 for bleeding. NNT for vascular complications and bleeding with postprocedural aspirin prophylaxis was 5.5 and 6.42, respectively.
  
  
  CONCLUSIONS
  Aspirin after TAVI appears to be beneficial than currently recommended dual antiplatelet therapy; therefore, it might be considered as TAVI antithrombotic prophylaxis.
authors.affiliation: Intensive Cardiac Therapy Department, Institute of Cardiology, Warsaw, Poland. Electronic address: kasia_czerwinska@vp.pl.
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Czerwińska-Jelonkiewicz
authors.affiliation: Department of Cardiac Surgery and Transplantology, Silesian Center for Heart Diseases, Zabrze, Poland.
authors.forename: Marian
authors.initials: M
authors.lastname: Zembala
authors.affiliation: Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland.
authors.forename: Maciej
authors.initials: M
authors.lastname: Dąbrowski
authors.affiliation: Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland.
authors.forename: Adam
authors.initials: A
authors.lastname: Witkowski
authors.affiliation: 7th Public Hospital of the Silesian Medical University, Katowice, Poland.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Ochała
authors.affiliation: 1(st) Department of Cardiology, Medical University of Warsaw, Poland.
authors.forename: Janusz
authors.initials: J
authors.lastname: Kochman
authors.affiliation: Jagiellonian University Medical College, Krakow, Poland.
authors.forename: Dariusz
authors.initials: D
authors.lastname: Dudek
authors.affiliation: Medical University, Military Hospital, Wroclaw, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Kübler
authors.affiliation: Department of Cardiac and Vascular Surgery, Medical University, Gdańsk, Poland.
authors.forename: Dariusz
authors.initials: D
authors.lastname: Jagielak
authors.affiliation: Intensive Cardiac Therapy Department, Institute of Cardiology, Warsaw, Poland.
authors.forename: Janina
authors.initials: J
authors.lastname: Stępińska
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000601:surgery*; D001241:Aspirin / Q000627:therapeutic use*; D001705:Bioprosthesis; D005260:Female; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D011044:Poland; D011183:Postoperative Complications / Q000453:epidemiology*; D012042:Registries; D012189:Retrospective Studies; D065467:Transcatheter Aortic Valve Replacement
chemical_list: D010975:Platelet Aggregation Inhibitors; D001241:Aspirin
keywords: Bleeding; Dual antiplatelet therapy; Transcatheter aortic valve implantation; Vascular complications