Anticoagulation In TAVI-Patients - Do We Need Dual Platelet Therapy?

Objective: Anticoagulant regimen in TAVI patients are discussed controversially but are not based on designated randomized trials or official recommendations. However, different strategies about the antiplatelet therapy or even vitamin K antagonists are daily practice.

Methods: Data of 575 prospectively enrolled TAVI patients were analyzed. Complications of bleeding, neurological events and re-hospitalization for cardiac reasons were evaluated for the early and mid-term follow-up (< 5y), respectively. Patients with single platelet therapy (SPT, group 1, n = 312) were compared with those with dual platelet therapy (DPT, group 2, n = 120) and vitamin K antagonists (VKA, group 3, n = 143).

Results: Demographic data were different between the groups (EuroSCORE: 32.0 ± 17.6 versus 26.7 ± 15.9 versus 35.6 ± 18.8, p < 0.001). Patients with single platelet therapy received more often transapical TAVI and patients with dual platelet therapy dominantly transfemoral TAVI. 30day mortality differed significantly (9.6% versus 3.3% versus 16.1%, p = 0.003). Transient and sustaining neurological events occurred equivalent in all groups during hospital stay (p = 0.492). Within the follow up group 3 patients had a higher stroke incidence (3.8% versus 3.3% versus 4.2%, p = 0.001). However, bleeding complications (p = 0.304) as well as re-hospitalization for cardiac reasons (p = 0.355) did not differ during follow up. According to the lower pre-operative EuroSCORE long-term survival was significantly better for group 2 patients (see below).

Conclusions: Patients with vitamin K antagonist therapy had a worse outcome regarding the 30day mortality. Neurological events during the follow up are more frequent compared with patients with antiplatelet therapy.

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