Virtual ACC 2020 | POPULAR TAVR: Post TAVR Anticoagulation without Clopidogrel?

In patients undergoing transcatheter aortic valve replacement (TAVR) that also required anticoagulation for another indication (mostly atrial fibrillation), the incidence of major bleeding between month 1 and 12 was lower in those receiving only anticoagulation instead of anticoagulation + clopidogrel. 

ACC 2020 Virtual | POPULAR TAVI: ¿anticoagulación sin clopidogrel post TAVI?

The present study presented as part of the scientific sessions at the virtual ACC 2020, simultaneously published in NEJM included TAVR patients with prior anticoagulation adequately indicated. Patients were randomized 1:1 to no clopidogrel (only anticoagulation) vs clopidogrel and anticoagulation for 3 months.

Primary end points were all bleedings not related to the procedure at 12 months. Secondary end points were a combination of cardiovascular death, bleeding not related to the procedure, stroke and MI.

Bleeding events occurred in 21.7% (34 of 157) of those receiving only anticoagulation vs 34.6% (54 of 156) of those receiving anticoagulation plus clopidogrel (RR 0.63; IC 95% 0.43 to 0.90; p=0.01). Most bleeding events were at the access site.


Read also: Virtual ACC 2020 | Controversial Trial ISCHEMIA Finally in NEJM.


Bleeding events not related to the procedure occurred in 21.7% vs 34%, respectively (RR 0.64; CI 95% 0.44 to 0.92; p=0.02). Most bleeding events occurred in the first month and were minor. 

Conclusion

In TAVR patients with prior anticoagulation indication a strategy with no antiplatelet antiaggregation (clopidogrel) and only anticoagulation resulted safer.

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Original Title: Anticoagulation with or without Clopidogrel after Transcatheter Aortic-Valve Implantation.

Reference: V.J. Nijenhuis et al. NEJM 2020, article in press.


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