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Antithrombotic treatment in transcatheter aortic valve implantation: insights for cerebrovascular and bleeding events.

Publication ,  Journal Article
Rodés-Cabau, J; Dauerman, HL; Cohen, MG; Mehran, R; Small, EM; Smyth, SS; Costa, MA; Mega, JL; O'Donoghue, ML; Ohman, EM; Becker, RC
Published in: J Am Coll Cardiol
December 24, 2013

Transcatheter aortic valve implantation (TAVI) has emerged as a therapeutic alternative for patients with symptomatic aortic stenosis at high or prohibitive surgical risk. However, patients undergoing TAVI are also at high risk for both bleeding and stroke complications, and specific mechanical aspects of the procedure itself can increase the risk of these complications. The mechanisms of periprocedural bleeding complications seem to relate mainly to vascular/access site complications (related to the use of large catheters in a very old and frail elderly population), whereas the pathophysiology of cerebrovascular events remains largely unknown. Further, although mechanical complications, especially the interaction between the valve prosthesis and the native aortic valve, may play a major role in events that occur during TAVI, post-procedural events might also be related to a prothrombotic environment or state generated by the implanted valve, the occurrence of atrial arrhythmias, and associated comorbidities. Antithrombotic therapy in the setting of TAVI has been empirically determined, and unfractionated heparin during the procedure followed by dual antiplatelet therapy with aspirin (indefinitely) and clopidogrel (1 to 6 months) is the most commonly recommended treatment. However, bleeding and cerebrovascular events are common; these may be modifiable with optimization of periprocedural and post-procedural pharmacology. Further, as the field of antiplatelet and anticoagulant therapy evolves, potential drug combinations will multiply, introducing variability in treatment. Randomized trials are the best path forward to determine the balance between the efficacy and risks of antithrombotic treatment in this high risk-population.

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Published In

J Am Coll Cardiol

DOI

EISSN

1558-3597

Publication Date

December 24, 2013

Volume

62

Issue

25

Start / End Page

2349 / 2359

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Risk Factors
  • Postoperative Hemorrhage
  • Humans
  • Heart Valve Prosthesis Implantation
  • Fibrinolytic Agents
  • Cerebrovascular Disorders
  • Cardiovascular System & Hematology
  • Cardiac Catheterization
  • Animals
 

Citation

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Rodés-Cabau, J., Dauerman, H. L., Cohen, M. G., Mehran, R., Small, E. M., Smyth, S. S., … Becker, R. C. (2013). Antithrombotic treatment in transcatheter aortic valve implantation: insights for cerebrovascular and bleeding events. J Am Coll Cardiol, 62(25), 2349–2359. https://doi.org/10.1016/j.jacc.2013.03.029
Rodés-Cabau, Josep, Harold L. Dauerman, Mauricio G. Cohen, Roxana Mehran, Eric M. Small, Susan S. Smyth, Marco A. Costa, et al. “Antithrombotic treatment in transcatheter aortic valve implantation: insights for cerebrovascular and bleeding events.J Am Coll Cardiol 62, no. 25 (December 24, 2013): 2349–59. https://doi.org/10.1016/j.jacc.2013.03.029.
Rodés-Cabau J, Dauerman HL, Cohen MG, Mehran R, Small EM, Smyth SS, et al. Antithrombotic treatment in transcatheter aortic valve implantation: insights for cerebrovascular and bleeding events. J Am Coll Cardiol. 2013 Dec 24;62(25):2349–59.
Rodés-Cabau, Josep, et al. “Antithrombotic treatment in transcatheter aortic valve implantation: insights for cerebrovascular and bleeding events.J Am Coll Cardiol, vol. 62, no. 25, Dec. 2013, pp. 2349–59. Pubmed, doi:10.1016/j.jacc.2013.03.029.
Rodés-Cabau J, Dauerman HL, Cohen MG, Mehran R, Small EM, Smyth SS, Costa MA, Mega JL, O’Donoghue ML, Ohman EM, Becker RC. Antithrombotic treatment in transcatheter aortic valve implantation: insights for cerebrovascular and bleeding events. J Am Coll Cardiol. 2013 Dec 24;62(25):2349–2359.
Journal cover image

Published In

J Am Coll Cardiol

DOI

EISSN

1558-3597

Publication Date

December 24, 2013

Volume

62

Issue

25

Start / End Page

2349 / 2359

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Risk Factors
  • Postoperative Hemorrhage
  • Humans
  • Heart Valve Prosthesis Implantation
  • Fibrinolytic Agents
  • Cerebrovascular Disorders
  • Cardiovascular System & Hematology
  • Cardiac Catheterization
  • Animals