Anticoagulation with or without Clopidogrel after Transcatheter Aortic-Valve Implantation
RCT (n=313) found that in patients undergoing TAVI, composite of death from cardiovascular causes, non–procedure-related bleeding, stroke, or myocardial infarction was lower for anticoagulation (AC) alone vs AC plus clopidogrel (31.2% vs 45.5%, -14.3%, 95% CI -25.0 to -3.6).
Source:
New England Journal of Medicine
SPS commentary:
A related editorial highlights that TAVI is a breakthrough technique, providing a less invasive alternative to surgery for most patients with aortic stenosis, with similar benefit in terms of survival and quality of life. The development of safe and effective procedural and long-term antithrombotic regimens, especially for patients receiving oral anticoagulants, is warranted. In this trial, the selection of bleeding as the primary outcome and its high frequency in the trial emphasise the importance of this event. The ideal would be an anticoagulant regimen that minimises the risk of death, stroke, myocardial infarction, or permanent disability, whether resulting from thrombosis or bleeding. These are the events that matter most to patients. Future trials assessing antithrombotic regimens for patients undergoing TAVI should be powered to evaluate these adverse outcomes.