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tavr antiplatelet

Stephan Windecker, Jan Tijssen, Gennaro Giustino, Ana H C Guimarães, Roxana Mehran, Marco Valgimigli, Pascal Vranckx, Robert C Welsh, Usman Baber, Gerrit-Anne van Es, Peter Wildgoose, Albert A Volkl, Ana Zazula, Karen Thomitzek, Melanie Hemmrich, George D Dangas
BACKGROUND: Optimal antithrombotic treatment after transcatheter aortic valve replacement (TAVR) is unknown and determined empirically. The direct factor Xa inhibitor rivaroxaban may potentially reduce TAVR-related thrombotic complications and premature valve failure. DESIGN: GALILEO is an international, randomized, open-label, event-driven, phase III trial in more than 1,520 patients without an indication for oral anticoagulation who underwent a successful TAVR (ClinicalTrials...
October 31, 2016: American Heart Journal
Samir Kapadia, Shikhar Agarwal, D Craig Miller, John G Webb, Michael Mack, Stephen Ellis, Howard C Herrmann, Augusto D Pichard, E Murat Tuzcu, Lars G Svensson, Craig R Smith, Jeevanantham Rajeswaran, John Ehrlinger, Susheel Kodali, Raj Makkar, Vinod H Thourani, Eugene H Blackstone, Martin B Leon
BACKGROUND: Prior studies of stroke and transient ischemic attack (TIA) after transcatheter aortic valve replacement (TAVR) are limited by reporting and follow-up variability. This is a comprehensive analysis of time-related incidence, risk factors, and outcomes of these events. METHODS AND RESULTS: From April 2007 to February 2012, 2621 patients, aged 84±7.2 years, underwent transfemoral (TF; 1521) or transapical (TA; 1100) TAVR in the PARTNER trial (Placement of Aortic Transcatheter Valves; as-treated), including the continued access registry...
September 2016: Circulation. Cardiovascular Interventions
Omar Abdul-Jawad Altisent, Eric Durand, Antonio J Muñoz-García, Luis Nombela-Franco, Asim Cheema, Joelle Kefer, Enrique Gutierrez, Luis M Benítez, Ignacio J Amat-Santos, Vicenç Serra, Helene Eltchaninoff, Sami M Alnasser, Jaime Elízaga, Antonio Dager, Bruno García Del Blanco, Maria Del Rosario Ortas-Nadal, Josep Ramon Marsal, Francisco Campelo-Parada, Ander Regueiro, Maria Del Trigo, Eric Dumont, Rishi Puri, Josep Rodés-Cabau
OBJECTIVES: The study sought to examine the risk of ischemic events and bleeding episodes associated with differing antithrombotic strategies in patients undergoing transcatheter aortic valve replacement (TAVR) with concomitant atrial fibrillation (AF). BACKGROUND: Guidelines recommend antiplatelet therapy (APT) post-TAVR to reduce the risk of stroke. However, data on the efficacy and safety of this recommendation in the setting of a concomitant indication for oral anticoagulation (due to atrial fibrillation [AF]) with a vitamin K antagonist (VKA) are scarce...
August 22, 2016: JACC. Cardiovascular Interventions
Eric Van Belle, Christian Hengstenberg, Thierry Lefevre, Christian Kupatt, Nicolas Debry, Oliver Husser, François Pontana, Grégory Kuchcinski, Efthymios N Deliargyris, Roxana Mehran, Debra Bernstein, Prodromos Anthopoulos, George D Dangas
BACKGROUND: Cerebral embolization is a frequent complication after transcatheter aortic valve replacement (TAVR). We hypothesized that cerebral embolization may be reduced by anticoagulation with bivalirudin during TAVR. OBJECTIVES: This study sought to determine the proportion of patients with new cerebral embolus after TAVR and to investigate whether parenteral procedural anticoagulation strategies affect cerebral embolization. METHODS: The BRAVO (Effect of Bivalirudin on Aortic Valve Intervention Outcomes)-3 randomized trial compared bivalirudin with unfractionated heparin in patients undergoing transfemoral TAVR...
August 9, 2016: Journal of the American College of Cardiology
Thomas G Gleason, John T Schindler, David H Adams, Michael J Reardon, Neal S Kleiman, Louis R Caplan, John V Conte, G Michael Deeb, G Chad Hughes, Sharla Chenoweth, Jeffrey J Popma
OBJECTIVES: This study was designed to characterize the incidence of new clinically detectable neurologic events, or any comparative change in indices of higher cognitive function following transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR) within the framework of a prospective, randomized clinical trial for high-risk patients. METHODS: High-risk patients (predicted SAVR mortality 15%) with severe aortic stenosis (n = 750) were randomized 1:1 to TAVR or SAVR and underwent evaluation using the National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale assessment at each follow-up and any suspected event...
July 2016: Journal of Thoracic and Cardiovascular Surgery
Patrizio Pascale, Julien Regamey, Juan F Iglesias, Vincent Gabus, Mathieu Clair, Patrick Yerly, Roger Hullin, Olivier Müller, Éric Eeckhout, Pierre Vogt
The present review provides a selected choice of clinical trials and therapeutic advances in the field of cardiology in 2015. A new treatment option in heart failure will become available this year in Switzerland. In interventional cardiology, new trials have been published on the duration of dual antiplatelet therapy, the new stents with bioresorbable scaffold and the long-term results of TAVR in patients who are not surgical candidates or at high surgical risk. RegardingAF the BRIDGE trial provides new evidences to guide the management of patients during warfarin interruption for surgery...
January 13, 2016: Revue Médicale Suisse
Manolis Vavuranakis, Angelos-Michail Kolokathis, Dimitrios A Vrachatis, Konstantinos Kalogeras, Nikolaos A Magkoutis, Sabi Fradi, Saïd Ghostine, Marianna Karamanou, Dimitrios Tousoulis
INTRODUCTION: Aortic stenosis is one of the most frequent valvulopathy of modern time necessitating interventional therapy when symptoms arise and stenosis becomes severe. First line treatment has traditionally been surgical aortic valve replacement (SAVR). However in the last decade transcatheter aortic valve implantation (TAVI) with bioprosthetic valves has proved to be a sound solution for high-risk for SAVR or inoperable patients. As expected implantation of the bioprosthetic device requires administration of antiplatelet regimen to the patients for a certain period...
2016: Current Pharmaceutical Design
Luis Nombela-Franco, María del Trigo, Guillermo Morrison-Polo, Gabriela Veiga, Pilar Jimenez-Quevedo, Omar Abdul-Jawad Altisent, Francisco Campelo-Parada, Corina Biagioni, Rishi Puri, Robert DeLarochellière, Eric Dumont, Daniel Doyle, Jean-Michel Paradis, Alicia Quirós, Carlos Almeria, Nieves Gonzalo, Ivan Nuñez-Gil, Pablo Salinas, Siamak Mohammadi, Javier Escaned, Antonio Fernández-Ortiz, Carlos Macaya, Josep Rodés-Cabau
OBJECTIVES: The aim of this study was to determine the incidence, causes, and predictors of unplanned hospital readmissions after transcatheter aortic valve replacement (TAVR). BACKGROUND: Data regarding unplanned hospital readmissions after TAVR in a real-world all-comers population are scarce. METHODS: A total of 720 consecutive patients undergoing TAVR at 2 centers who survived the procedure, were included. Median follow-up was 23 months (interquartile range [IQR]: 12 to 39 months), available in 99...
November 2015: JACC. Cardiovascular Interventions
Raj R Makkar, Gregory Fontana, Hasan Jilaihawi, Tarun Chakravarty, Klaus F Kofoed, Ole de Backer, Federico M Asch, Carlos E Ruiz, Niels T Olsen, Alfredo Trento, John Friedman, Daniel Berman, Wen Cheng, Mohammad Kashif, Vladimir Jelnin, Chad A Kliger, Hongfei Guo, Augusto D Pichard, Neil J Weissman, Samir Kapadia, Eric Manasse, Deepak L Bhatt, Martin B Leon, Lars Søndergaard
BACKGROUND: A finding of reduced aortic-valve leaflet motion was noted on computed tomography (CT) in a patient who had a stroke after transcatheter aortic-valve replacement (TAVR) during an ongoing clinical trial. This finding raised a concern about possible subclinical leaflet thrombosis and prompted further investigation. METHODS: We analyzed data obtained from 55 patients in a clinical trial of TAVR and from two single-center registries that included 132 patients who were undergoing either TAVR or surgical aortic-valve bioprosthesis implantation...
November 19, 2015: New England Journal of Medicine
Suzanne Fateh-Moghadam, Sabrina Voesch, Patrik Htun, Rezo Jorbenadze, Tobias Geisler, Meinrad Gawaz, Wolfgang Bocksch
Stroke and thromboembolic events after transfemoral aortic valve replacement (TAVR) continue to be a problem. The aim of our study was to compare platelet aggregation (Agg) and platelet activation (PA) observed with two different catheter valves, the ESV-XT and the newer ESV-3 valve in patients (pts) undergoing TAVR on dual antiplatelet therapy (DAPT). A total of 174 patients with severe aortic stenosis and high surgical risk successfully underwent TAVR (60 ESV-XT; 114 ESV-3). Platelet Agg and PA (CD62P expression) were evaluated before and the following three days after TAVR under DAPT...
January 2016: Thrombosis and Haemostasis
Lee H Sterling, Sarah B Windle, Kristian B Filion, Mark J Eisenberg
BACKGROUND: The most appropriate pharmacological treatment for stroke prevention after transcatheter aortic valve replacement (TAVR) is unclear. We performed a systematic review of randomized controlled trials (RCTs) and observational studies examining the effect of various pharmacological treatment regimens on rates of stroke, bleeding, and death after TAVR. METHODS: We searched Cochrane Library, Embase, and Medline for RCTs and observational studies comparing ≥2 antithrombotic regimens in TAVR patients...
July 15, 2015: International Journal of Cardiology
Eduardo De Marchena, Julian Mesa, Sydney Pomenti, Christian Marin Y Kall, Ximena Marincic, Kazuyuki Yahagi, Elena Ladich, Robert Kutz, Yaar Aga, Michael Ragosta, Atul Chawla, Michael E Ring, Renu Virmani
OBJECTIVES: This paper reviews the published data and reports 3 cases of thrombosis involving CoreValve (Medtronic, Minneapolis, Minnesota) and 1 involving Edward Sapien (Edwards Lifesciences, Irvine, California) devices. Three of these cases had pathological findings at autopsy. BACKGROUND: Only a limited number of cases of valve dysfunction with rapid increase of transvalvular aortic gradients or aortic insufficiency post-transcatheter aortic valve replacement (TAVR) have been described...
April 27, 2015: JACC. Cardiovascular Interventions
M Moser
Interventional treatment of aortic valve stenosis by transcatheter aortic valve replacement (TAVR) has become routine practice in elderly and high risk patients in recent years. Similar to other vascular interventional or surgical procedures TAVR carries thrombotic risks such as stroke, myocardial infarction or systemic embolism as well as peri-procedural bleeding risks. These risks comprise the access site, the type of prosthesis, and the individual risk profile of the patient. Not only during the peri-procedural period but also during longterm follow-up the current target population for TAVR procedures carries a high risk for thrombotic events in particular if atrial fibrillation is present...
2016: Hämostaseologie
Madan Raj Aryal, Paras Karmacharya, Anil Pandit, Fayaz Hakim, Ranjan Pathak, Naba Raj Mainali, Anene Ukaigwe, Maryam Mahmood, Madan Badal, F David Fortuin
BACKGROUND: Although dual antiplatelet therapy (DAPT) with clopidogrel and aspirin is a widely accepted strategy in patients undergoing transcatheter aortic valve replacement (TAVR), this approach is not evidence based. We therefore sought to systematically review the current evidence for this practice in terms of 30-day outcome looking at stroke, MI, bleeding, and death. METHODS: Relevant studies were identified through electronic literature search. Studies involving single antiplatelet therapy (SAPT) and DAPT in patients undergoing TAVR were included...
February 2015: Heart, Lung & Circulation
Estella M Davis, Stacey K Friedman, Thomas M Baker
Aortic stenosis (AS) is a common valvular pathological finding in older adults. A latent period followed by rapid progression after the onset of symptoms can result in a high rate of death if left untreated. Aortic valve replacement (AVR) remains the standard of care for patients with severe symptomatic AS; however, due to comorbidities and age, patients may be ineligible for surgical AVR. Transcatheter AVR (TAVR) is an alternative treatment for patients with severe symptomatic AS for whom surgery is not an option...
January 2013: Postgraduate Medicine
Melissa Fusari
OBJECTIVES: This paper reviews literary evidence on antithrombotic therapies currently employed in TAVR to assess validity and efficacy; duration and modality are also considered. In the absence of firm guidelines and reliable trial results, we analyze current knowledge of interaction between PPI and antithrombotic drugs. BACKGROUND: TAVR has been associated with Double Antiplatelet Therapy since 2002. This was an empirical approach for a new stentmounted tissue valve to prevent early and late MACCE that affect survival and quality of life...
2013: Current Pharmaceutical Design
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