AAS vs Warfarin in Low Risk TAVR

We are still discussing the adequate antithrombotic scheme after transcatheter aortic valve replacement (TAVR). Additionally, we are treating a much wider array of patients ranging from low risk to inoperable. 

AAS vs Warfarina en TAVI de bajo riesgo

And there is yet one more important point: hypo-attenuated leaflet thickening diagnosed by CT. We are still unaware of the impact they have on device durability at long term, which is overly concerning in low-risk patients.  

This study recently published in Circ Cardiovasc Interv has tried to answer some of the questions above. The study openly randomized 1:1 low risk patients undergoing transfemoral TAVR to low-dose aspirin or warfarin plus low-dose aspirin for 30 days. 

It used CT or transesophageal echocardiography after one month to assess the presence of hypo-attenuated leaflet thickening, reduced leaflet motion, mean gradient ≥20 mm Hg, effective orifice area ≤1.0 cm2, moderate or severe regurgitation, stroke, or transient ischemic attack.


Read also: Medical Therapy Optimization Achieved Prior Clinical Trial.


50 patients received aspirin and 44 warfarin plus aspirin, and 30 who could not be randomized were enrolled into a registry.

The primary end point occurred in 26.5% of patients receiving aspirin vs. 7% of patient receiving aspirin and warfarin (p=0.014; OR 4.8). The difference was based on hypo-attenuated leaflet thickening rate (16.3% vs 4.8%; p=0.07).

There was no excess bleeding with warfarin during the first 30 days. 

Conclusion

In low-risk patients undergoing TAVR, anticoagulation with warfarin could prevent leaflet dysfunction at short term with no excess bleeding. 

Original Title: Randomized Trial of Aspirin Versus Warfarin After Transcatheter Aortic Valve Replacement in Low-Risk Patients.

Reference: Toby Rogers et al. Circ Cardiovasc Interv. 2021 Jan;14(1):e009983. doi: 10.1161/CIRCINTERVENTIONS.120.009983.


Subscribe to our weekly newsletter

Get the latest scientific articles on interventional cardiology

 

More articles by this author

TCT 2024 | TRISCEND II

This randomized study included 400 patients; 267 were treated with EVOQUE valve and 133 with optimal medical treatment (OMT). After one-year follow-up, there were no...

TCT 2024 – ACCESS-TAVI: Comparing Percutaneous Access Closure Strategies After TAVI

Vascular access complications following transcatheter aortic valve implantation (TAVI) remain common. However, few studies compare vascular access closure methods.  Based on the CHOICE-CLOSURE and MASH...

STEACS and the Use of Bivalirudin vs. Heparin: In Search of BRIGHT-4 Outcomes

Various studies and registries have previously shown the impact of post-percutaneous coronary intervention (PCI) complications on the survival of patients with ST-segment elevation acute...

TAVR in Young Low-Risk Patients

Transcatheter aortic valve replacement (TAVR) has established itself as an effective strategy for the treatment of severe aortic stenosis across different risk groups. While previous...

LEAVE A REPLY

Please enter your comment!
Please enter your name here

Related Articles

SOLACI Sessionsspot_img

Recent Articles

TCT 2024 | FAVOR III EUROPA

The study FAVOR III EUROPA, a randomized trial, included 2,000 patients with chronic coronary syndrome, or stabilized acute coronary syndrome, and intermediate lesions. 1,008...

TCT 2024 | TRISCEND II

This randomized study included 400 patients; 267 were treated with EVOQUE valve and 133 with optimal medical treatment (OMT). After one-year follow-up, there were no...

TCT 2024 – ACCESS-TAVI: Comparing Percutaneous Access Closure Strategies After TAVI

Vascular access complications following transcatheter aortic valve implantation (TAVI) remain common. However, few studies compare vascular access closure methods.  Based on the CHOICE-CLOSURE and MASH...