Which is the best antiaggregant or anticoagulant therapy after TAVI? A propensity-matched analysis from the ITER registry. The management of DAPT after TAVI

Fabrizio D'Ascenzo, Umberto Benedetto, Matteo Bianco, Federico Conrotto, Claudio Moretti, Augusto D'Onofrio, Marco Agrifoglio, Antonio Colombo, Flavio Ribichini, Giuseppe Tarantini, Maurizio D'Amico, Stefano Salizzoni, Mauro Rinaldi, Alaide Chieffo, Gennaro Giustino, Tommaso Regesta, Massimo Napodano, Davide Gabbieri, Francesco Saia, Corrado TamburinoDiego Cugola, Marco Aiello, Francesco Sanna, Alessandro Iadanza, Esmeralda Pompei, Pierluigi Stefàno, Antioco Cappai, Alessandro Minati, Mauro Cassese, Gian Luca Martinelli, Andrea Agostinelli, Rosario Fiorilli, Francesco Casilli, Maurizio Reale, Francesco Bedogni, Anna Sonia Petronio, Pierluigi Omedè, Antonio Montefusco, Rosa Alba Mozzillo, Roberto Bonmassari, Carlo Briguori, Armando Liso, Gennaro Sardella, Giuseppe Bruschi, Gino Gerosa, Francesco Romeo, on behalf of the ITER Investigators

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Aims: The safety and efficacy of single vs. dual antiplatelet therapy (DAPT) in patients undergoing TAVI remain to be addressed. The aim of our study was to evaluate the usefulness of a DAPT compared to a single platelet therapy in patients undergoing TAVI with a balloon-expandable prosthesis. Methods and results: All consecutive patients enrolled in the ITER registry were included. Patients undergoing TAVI discharged with aspirin alone were compared to those taking DAPT before and after selection using propensity score with matching. Subgroup analysis was performed for those on OAT. Prosthetic heart valve dysfunction at follow-up was the primary endpoint, whereas all-cause death, cardiovascular death, bleedings, vascular complications and cerebrovascular accidents were the secondary ones. From 1,364 patients, after propensity score with matching, 605 were selected for each group (aspirin alone vs. DAPT). At 30 days, rates of VARC mortality were lower in patients with aspirin alone (1.5% vs. 4.1%, p=0.003), mainly driven by a reduction of major vascular complications (5.3% vs. 10.7%, p<0.001) and of major bleedings (6.6% vs. 11.5%, p<0.001), without a difference in prosthetic heart valve dysfunction after 45±14 months (2.8% vs. 3.0%, p=0.50). These results were confirmed on multivariable analysis. Conclusions: After TAVI with a balloon-expandable prosthesis, aspirin alone does not increase the risk of prosthetic valve dysfunction, and reduces the risk of periprocedural complications and of 30-day all-cause death.

Original languageEnglish
Pages (from-to)e1392-e1400
JournalEuroIntervention
Volume13
Issue number12
DOIs
Publication statusPublished - Dec 1 2017

Fingerprint

Anticoagulants
Registries
Aspirin
Propensity Score
Heart Valves
Prostheses and Implants
Blood Vessels
Cause of Death
Therapeutics
Hemorrhage
Blood Platelets
Stroke
Safety
Mortality

Keywords

  • Aortic stenosis
  • Clinical research
  • Transcatheter aortic valve implantation (TAVI)

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

D'Ascenzo, F., Benedetto, U., Bianco, M., Conrotto, F., Moretti, C., D'Onofrio, A., ... on behalf of the ITER Investigators (2017). Which is the best antiaggregant or anticoagulant therapy after TAVI? A propensity-matched analysis from the ITER registry. The management of DAPT after TAVI. EuroIntervention, 13(12), e1392-e1400. https://doi.org/10.4244/EIJ-D-17-00198

Which is the best antiaggregant or anticoagulant therapy after TAVI? A propensity-matched analysis from the ITER registry. The management of DAPT after TAVI. / D'Ascenzo, Fabrizio; Benedetto, Umberto; Bianco, Matteo; Conrotto, Federico; Moretti, Claudio; D'Onofrio, Augusto; Agrifoglio, Marco; Colombo, Antonio; Ribichini, Flavio; Tarantini, Giuseppe; D'Amico, Maurizio; Salizzoni, Stefano; Rinaldi, Mauro; Chieffo, Alaide; Giustino, Gennaro; Regesta, Tommaso; Napodano, Massimo; Gabbieri, Davide; Saia, Francesco; Tamburino, Corrado; Cugola, Diego; Aiello, Marco; Sanna, Francesco; Iadanza, Alessandro; Pompei, Esmeralda; Stefàno, Pierluigi; Cappai, Antioco; Minati, Alessandro; Cassese, Mauro; Martinelli, Gian Luca; Agostinelli, Andrea; Fiorilli, Rosario; Casilli, Francesco; Reale, Maurizio; Bedogni, Francesco; Petronio, Anna Sonia; Omedè, Pierluigi; Montefusco, Antonio; Mozzillo, Rosa Alba; Bonmassari, Roberto; Briguori, Carlo; Liso, Armando; Sardella, Gennaro; Bruschi, Giuseppe; Gerosa, Gino; Romeo, Francesco; on behalf of the ITER Investigators.

In: EuroIntervention, Vol. 13, No. 12, 01.12.2017, p. e1392-e1400.

Research output: Contribution to journalArticle

D'Ascenzo, F, Benedetto, U, Bianco, M, Conrotto, F, Moretti, C, D'Onofrio, A, Agrifoglio, M, Colombo, A, Ribichini, F, Tarantini, G, D'Amico, M, Salizzoni, S, Rinaldi, M, Chieffo, A, Giustino, G, Regesta, T, Napodano, M, Gabbieri, D, Saia, F, Tamburino, C, Cugola, D, Aiello, M, Sanna, F, Iadanza, A, Pompei, E, Stefàno, P, Cappai, A, Minati, A, Cassese, M, Martinelli, GL, Agostinelli, A, Fiorilli, R, Casilli, F, Reale, M, Bedogni, F, Petronio, AS, Omedè, P, Montefusco, A, Mozzillo, RA, Bonmassari, R, Briguori, C, Liso, A, Sardella, G, Bruschi, G, Gerosa, G, Romeo, F & on behalf of the ITER Investigators 2017, 'Which is the best antiaggregant or anticoagulant therapy after TAVI? A propensity-matched analysis from the ITER registry. The management of DAPT after TAVI', EuroIntervention, vol. 13, no. 12, pp. e1392-e1400. https://doi.org/10.4244/EIJ-D-17-00198
D'Ascenzo, Fabrizio ; Benedetto, Umberto ; Bianco, Matteo ; Conrotto, Federico ; Moretti, Claudio ; D'Onofrio, Augusto ; Agrifoglio, Marco ; Colombo, Antonio ; Ribichini, Flavio ; Tarantini, Giuseppe ; D'Amico, Maurizio ; Salizzoni, Stefano ; Rinaldi, Mauro ; Chieffo, Alaide ; Giustino, Gennaro ; Regesta, Tommaso ; Napodano, Massimo ; Gabbieri, Davide ; Saia, Francesco ; Tamburino, Corrado ; Cugola, Diego ; Aiello, Marco ; Sanna, Francesco ; Iadanza, Alessandro ; Pompei, Esmeralda ; Stefàno, Pierluigi ; Cappai, Antioco ; Minati, Alessandro ; Cassese, Mauro ; Martinelli, Gian Luca ; Agostinelli, Andrea ; Fiorilli, Rosario ; Casilli, Francesco ; Reale, Maurizio ; Bedogni, Francesco ; Petronio, Anna Sonia ; Omedè, Pierluigi ; Montefusco, Antonio ; Mozzillo, Rosa Alba ; Bonmassari, Roberto ; Briguori, Carlo ; Liso, Armando ; Sardella, Gennaro ; Bruschi, Giuseppe ; Gerosa, Gino ; Romeo, Francesco ; on behalf of the ITER Investigators. / Which is the best antiaggregant or anticoagulant therapy after TAVI? A propensity-matched analysis from the ITER registry. The management of DAPT after TAVI. In: EuroIntervention. 2017 ; Vol. 13, No. 12. pp. e1392-e1400.
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abstract = "Aims: The safety and efficacy of single vs. dual antiplatelet therapy (DAPT) in patients undergoing TAVI remain to be addressed. The aim of our study was to evaluate the usefulness of a DAPT compared to a single platelet therapy in patients undergoing TAVI with a balloon-expandable prosthesis. Methods and results: All consecutive patients enrolled in the ITER registry were included. Patients undergoing TAVI discharged with aspirin alone were compared to those taking DAPT before and after selection using propensity score with matching. Subgroup analysis was performed for those on OAT. Prosthetic heart valve dysfunction at follow-up was the primary endpoint, whereas all-cause death, cardiovascular death, bleedings, vascular complications and cerebrovascular accidents were the secondary ones. From 1,364 patients, after propensity score with matching, 605 were selected for each group (aspirin alone vs. DAPT). At 30 days, rates of VARC mortality were lower in patients with aspirin alone (1.5{\%} vs. 4.1{\%}, p=0.003), mainly driven by a reduction of major vascular complications (5.3{\%} vs. 10.7{\%}, p<0.001) and of major bleedings (6.6{\%} vs. 11.5{\%}, p<0.001), without a difference in prosthetic heart valve dysfunction after 45±14 months (2.8{\%} vs. 3.0{\%}, p=0.50). These results were confirmed on multivariable analysis. Conclusions: After TAVI with a balloon-expandable prosthesis, aspirin alone does not increase the risk of prosthetic valve dysfunction, and reduces the risk of periprocedural complications and of 30-day all-cause death.",
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T1 - Which is the best antiaggregant or anticoagulant therapy after TAVI? A propensity-matched analysis from the ITER registry. The management of DAPT after TAVI

AU - D'Ascenzo, Fabrizio

AU - Benedetto, Umberto

AU - Bianco, Matteo

AU - Conrotto, Federico

AU - Moretti, Claudio

AU - D'Onofrio, Augusto

AU - Agrifoglio, Marco

AU - Colombo, Antonio

AU - Ribichini, Flavio

AU - Tarantini, Giuseppe

AU - D'Amico, Maurizio

AU - Salizzoni, Stefano

AU - Rinaldi, Mauro

AU - Chieffo, Alaide

AU - Giustino, Gennaro

AU - Regesta, Tommaso

AU - Napodano, Massimo

AU - Gabbieri, Davide

AU - Saia, Francesco

AU - Tamburino, Corrado

AU - Cugola, Diego

AU - Aiello, Marco

AU - Sanna, Francesco

AU - Iadanza, Alessandro

AU - Pompei, Esmeralda

AU - Stefàno, Pierluigi

AU - Cappai, Antioco

AU - Minati, Alessandro

AU - Cassese, Mauro

AU - Martinelli, Gian Luca

AU - Agostinelli, Andrea

AU - Fiorilli, Rosario

AU - Casilli, Francesco

AU - Reale, Maurizio

AU - Bedogni, Francesco

AU - Petronio, Anna Sonia

AU - Omedè, Pierluigi

AU - Montefusco, Antonio

AU - Mozzillo, Rosa Alba

AU - Bonmassari, Roberto

AU - Briguori, Carlo

AU - Liso, Armando

AU - Sardella, Gennaro

AU - Bruschi, Giuseppe

AU - Gerosa, Gino

AU - Romeo, Francesco

AU - on behalf of the ITER Investigators

PY - 2017/12/1

Y1 - 2017/12/1

N2 - Aims: The safety and efficacy of single vs. dual antiplatelet therapy (DAPT) in patients undergoing TAVI remain to be addressed. The aim of our study was to evaluate the usefulness of a DAPT compared to a single platelet therapy in patients undergoing TAVI with a balloon-expandable prosthesis. Methods and results: All consecutive patients enrolled in the ITER registry were included. Patients undergoing TAVI discharged with aspirin alone were compared to those taking DAPT before and after selection using propensity score with matching. Subgroup analysis was performed for those on OAT. Prosthetic heart valve dysfunction at follow-up was the primary endpoint, whereas all-cause death, cardiovascular death, bleedings, vascular complications and cerebrovascular accidents were the secondary ones. From 1,364 patients, after propensity score with matching, 605 were selected for each group (aspirin alone vs. DAPT). At 30 days, rates of VARC mortality were lower in patients with aspirin alone (1.5% vs. 4.1%, p=0.003), mainly driven by a reduction of major vascular complications (5.3% vs. 10.7%, p<0.001) and of major bleedings (6.6% vs. 11.5%, p<0.001), without a difference in prosthetic heart valve dysfunction after 45±14 months (2.8% vs. 3.0%, p=0.50). These results were confirmed on multivariable analysis. Conclusions: After TAVI with a balloon-expandable prosthesis, aspirin alone does not increase the risk of prosthetic valve dysfunction, and reduces the risk of periprocedural complications and of 30-day all-cause death.

AB - Aims: The safety and efficacy of single vs. dual antiplatelet therapy (DAPT) in patients undergoing TAVI remain to be addressed. The aim of our study was to evaluate the usefulness of a DAPT compared to a single platelet therapy in patients undergoing TAVI with a balloon-expandable prosthesis. Methods and results: All consecutive patients enrolled in the ITER registry were included. Patients undergoing TAVI discharged with aspirin alone were compared to those taking DAPT before and after selection using propensity score with matching. Subgroup analysis was performed for those on OAT. Prosthetic heart valve dysfunction at follow-up was the primary endpoint, whereas all-cause death, cardiovascular death, bleedings, vascular complications and cerebrovascular accidents were the secondary ones. From 1,364 patients, after propensity score with matching, 605 were selected for each group (aspirin alone vs. DAPT). At 30 days, rates of VARC mortality were lower in patients with aspirin alone (1.5% vs. 4.1%, p=0.003), mainly driven by a reduction of major vascular complications (5.3% vs. 10.7%, p<0.001) and of major bleedings (6.6% vs. 11.5%, p<0.001), without a difference in prosthetic heart valve dysfunction after 45±14 months (2.8% vs. 3.0%, p=0.50). These results were confirmed on multivariable analysis. Conclusions: After TAVI with a balloon-expandable prosthesis, aspirin alone does not increase the risk of prosthetic valve dysfunction, and reduces the risk of periprocedural complications and of 30-day all-cause death.

KW - Aortic stenosis

KW - Clinical research

KW - Transcatheter aortic valve implantation (TAVI)

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