While the benefits of dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor are recognized, its primary complication is the occurrence of bleeding events, which negatively impact patient morbidity and mortality. Additionally, about 10% of patients undergoing percutaneous coronary intervention (PCI) are on oral anticoagulant therapy, which significantly increases the risk of bleeding when…
ESC 2023 | Anticoagulation After Primary PCI in STEMI Patients
The empirical prescription of anticoagulants after percutaneous coronary intervention (PCI), also know as post-procedural anticoagulation (PPA), is nowadays a common practice that uses various types of medications. Despite studies like HORIZONS-AMI and EUROMAX, in which 41% of patients received PPA, and the CCC-ACS registry, where 75% of subjects received PPA after primary PCI, European and…
TRAPEUR Registry: Thrombus Trapping with Left Atrial Appendage Closure Device
Left atrial appendage closure (LAAC) devices are a good alternative for the prevention of systemic thromboembolism in patients with non-valvular atrial fibrillation (AF) and high risk of bleeding or those with anticoagulation contraindication. According to PRAGUE-17 outcomes, at 4 years, LAAC resulted non-inferior to direct anticoagulation in the prevention of cardiovascular, neurological, and bleeding events. …
Atrial Fibrillation and Dementia: Which Anticoagulant Agent Presents the Lowest Risk?
Atrial fibrillation is a risk factor for dementia and anticoagulant agents have been proven to decrease it. This work aims to find differences in the risk of dementia between patients treated with traditional choice warfarin vs. different direct anticoagulants. Between 2014 and 2017, this study enrolled 72,846 patients >40 years with nonvalvular atrial fibrillation who…
TAVR and Anticoagulation: Direct Anticoagulant Agents or Vitamin K Inhibitors?
In some patients, using an anticoagulant agent is not an option, it is just prescribed. Based on the French TAVR registry, this research compared long-term mortality, bleeding, and ischemic events after valve implantation. A comparison was made between TAVR and direct vs. classic anticoagulant agents—good old proven and reversible vitamin K inhibitors. Cardiologists, hematologists, clinicians, and…
Thrombotic and Bleeding Risk after TAVR: Quick Tips to Stay Up to Date
Transcatheter aortic valve replacement (TAVR) is an increasingly frequent option for patients with severe aortic stenosis across the entire risk spectrum. However, TAVR involves bleeding and thrombosis risk and therefore calls for an optimal adjuvant treatment. Any scheme is complex if we take into account most patients undergoing TAVR are generally elderly and have multiple…
ESC 2021 | ENVISAGE-TAVI AF: Surprise with Endoxaban in TAVR and Atrial Fibrillation
The enthusiasm for direct oral anticoagulants after transcatheter aortic valve replacements (TAVR) is waning. At least, when it combines with atrial fibrillation. The ENVISAGE-TAVI AF has shown excessive bleeding with endoxaban vs. the classical vitamin K antagonists. Endoxaban resulted non-inferior to vitamin K antagonists in terms of net clinical adverse events, but major bleeding events…
European Consensus on Antithrombotic Management in TAVR
All the controlled randomized evidence recently published called for an updated document on antithrombotic management in transcatheter aortic valve replacement (TAVR). While thrombotic and hemorrhagic complications have diminished over time—as both the technique and the devices have been perfected—, they still remain as common adverse events in TAVR. Recommendations in the 2017 European Guidelines were…
ACC 2021 | ATLANTIS 4D-CT: Apixaban and Sub-Clinical Thrombosis After TAVR
Indicating apixaban after transcatheter aortic valve replacement (TAVR) does not significantly reduce the risk of sub-clinical leaflet thrombosis compared with the standard of care. These data come from the computerized tomography (CT) scan sub-study from ATLANTIS, presented during the scientific sessions of the American College of Cardiology (ACC) 2021 Congress. In patients with no prior…
ACC 2021 | ATLANTIS: Apixaban After TAVR vs. Standard of Care
Adding apixaban to the treatment of patients undergoing transcatheter aortic valve replacement (TAVR) was non-superior to standard antithrombotic treatment, according to the randomized ATLANTIS trial presented today at the American College of Cardiology (ACC) 2021 Congress. Given its easy indication and good safety profile, it could be an option to vitamin K antagonists for patients with…