Anticoagulation Therapy Appears to Be Safe After TAVI
(HealthDay News) – After transcatheter aortic valve implantation (TAVI) there is no increased risk of bleeding or other adverse outcomes for those patients who have an indication for anticoagulant therapy.
Filippo Figini, MD, of the S. Raffaele Scientific Institute in Milan, and colleagues conducted a retrospective study using data from 360 patients who had undergone TAVI to examine the best antithrombotic approach. Anticoagulant therapy was indicated for 16.7% of participants, primarily due to atrial fibrillation. After clinical evaluation of thrombotic and hemorrhagic risk, 72% of these patients were discharged with warfarin plus a single antiplatelet drug. Their outcomes were compared to those of the 300 patients with no indication for anticoagulant therapy who were treated with dual antiplatelet therapy.
The researchers found that, during a median of 11 months of follow up, 15% of the study population died, and mortality did not correlate with antithrombotic regimen. The incidence of cerebral events (4.6%) and intracranial hemorrhage (1.1%) was low and was not significantly different between the groups. The bleeding rate was also similar between the groups.
"When anticoagulation is indicated after TAVI, many variables must be taken into account. The most frequent scenario in this study was patients in atrial fibrillation, most of whom were discharged with warfarin plus a single antiplatelet medication. When bleeding was a concern, especially in the absence of coronary disease, warfarin alone was prescribed," the authors write. "These results suggest that this approach is safe, but data from larger, randomized studies are needed."