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Medical management after TAVR generally safe
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Medical management of patients after transcatheter aortic valve replacement was safely managed by warfarin plus a single antiplatelet medication for atrial fibrillation or warfarin alone when bleeding was a concern, especially for patients without coronary disease, study results showed.
Researchers of the study appearing in the American Journal of Cardiology retrospectively analyzed data from 360 patients who underwent TAVR, of whom 60 (16.7%) had indications for anticoagulant treatment, mainly because of atrial fibrillation.
Clinical evaluation of thrombotic and hemorrhagic risk determined which antithrombotic regimen was assigned. Forty-three patients were discharged with warfarin (Coumadin, Bristol-Myers Squibb) plus a single antiplatelet drug. This cohort was compared with 300 patients with no indications for anticoagulation who were treated with dual antiplatelet therapy for 3 to 6 months.
During the follow-up period (median, 11 months), 53 patients (15%) died, but mortality was not associated with which antithrombotic regimen was used, the researchers noted.
Incident rates were low for cerebral events (4.6%) or intracranial hemorrhage (1.1%), and there were no significant differences between the two groups for incidents or bleeding rates.
“In general, we believe that patients who have indications for long-term anticoagulation should continue with this therapy irrespective of the TAVR procedure,” researchers wrote. “If the risk for bleeding by adding an antiplatelet medication is deemed too high, warfarin alone may be sufficient therapy. When poor compliance to anticoagulant therapy is expected or managing international normalized ratios is difficult, DAPT may be a valuable option.”
Disclosure: The researchers report no relevant financial disclosures.
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