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Management of antithrombotic/antiplatelet therapy in patients with aortic stenosis undergoing transcatheter aortic valve replacement

Session Poster Session 2

Speaker Manuel Munoz-Garcia

Congress : Heart Failure 2019

  • Topic : cardiovascular pharmacology
  • Sub-topic : Cardiovascular Drug Therapy, Other
  • Session type : Poster Session
  • FP Number : P1181

Authors : M Munoz-Garcia (Malaga,ES), E Munoz-Garcia (Malaga,ES), A J Munoz Garcia (Malaga,ES), JM Garcia-Pinilla (Malaga,ES), L Morcillo-Hidalgo (Malaga,ES), A Robles Mezcua (Malaga,ES), JH Alonso-Briales (Malaga,ES), JM Hernandez-Garcia (Malaga,ES), MF Jimenez-Navarro (Malaga,ES), JJ Gomez-Doblas (Malaga,ES)

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Authors:
M Munoz-Garcia1 , E Munoz-Garcia1 , A J Munoz Garcia1 , JM Garcia-Pinilla1 , L Morcillo-Hidalgo1 , A Robles Mezcua1 , JH Alonso-Briales1 , JM Hernandez-Garcia1 , MF Jimenez-Navarro1 , JJ Gomez-Doblas1 , 1University Hospital Virgen de la Victoria, Department of Cardiology - Malaga - Spain ,

Citation:

Background: Many cardiac patients undergoing transcatheter aortic valve implantation (TAVI) required combined antithrombotic therapy consisting of an anticoagulant and inhibition of platelet function. Currently the optimal combination of anticoagulants and anti-platelet therapy is unknown, but it is well established that the combination increased bleeding rates.
The aim of this study was to analyze prevalence ischaemic and bleeding events in patients undergoing TAVI in according to management of antithrombotic therapy
Methods: A total of 637 consecutive patients with aortic stenosis undergoing TAVI were evaluated, between April 2008 and December 201, on base to antithrombotic/antiplatelet therapy received at discharge.
Results: The patients were characterized by had a HAS-BLED score 2.8± 1.1, CHADS2 3.35±1.0 and CHAD2-Vasc score 5.08±1.2. In 53 patiens  (8.3%) were treated in monotherapy with an antiplatelet, dual antiplatelet in 424 (60.6%),  (3.2%) triple therapy in 29 patients (4.6%) and  131 patients (20.6%) with oral anticoagulant plus a thienopyridine.  We  found not differences  in mortality in according to antithrombotic therapy, respectively: 52.9% vs. 37.4% vs. 34.5% vs 47, [HR= 1.087 (95% CI 0.912-1.297), p=0.350], There were no differences in stroke 15.1% vs. 7.3% vs. 13.8% vs 10%, [HR=1.029 (95% CI 0.767-1.392), p=0.854], major bleeding 5.7% vs. 3.8% vs. 3.4% vs. 6.1% %, [HR=1.167 (95% CI 0.782-1.741), p=0.449], and myocardial infarction 1.9% vs. 3.8% vs. 3.4% vs. 0.8%, %, [HR=0.669 (95% CI 0.366-1.225), p=0.193].
Conclusions: in this study  there was no differences in rate of mortality or isquemic and hemorragic events, although there were trend to higher rate of mortality in patients with only antiplatelet and anticoagulant plus thienopyridine.

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