Antithrombotic Management Following Transcatheter Aortic Valve Replacement: A Survey of Canadian Physicians

Publication date: Available online 22 August 2019Source: Canadian Journal of CardiologyAuthor(s): Seleman Reza Bsc, Natalia Pinilla, Emilie P. Belley-Côté, Kevin J. Um, Serena Sibilio, Madhu K. Natarajan, Richard P. WhitlockAbstractOptimal post-procedural antithrombotic regimen is uncertain after transcatheter aortic valve replacement (TAVR). We developed an online questionnaire on post-TAVR antithrombotic management. After research ethics board approval, we distributed the survey to TAVR implanters across Canada. A total of 24 TAVR implanters from 17 centres responded to the survey for a response rate of 75%. Dual antiplatelet therapy (DAPT) for variable durations was the preferred initial treatment for patients in sinus rhythm following isolated TAVR, TAVR with a recent stent (≤1 month), and valve-in-valve procedures (71%, 96%, and 65%, respectively). Most respondents continued patients on ASA indefinitely after these procedures (100%, 92%, 90%, respectively). In patients with atrial fibrillation, the CHA2DS2-VASC score was the preferred stroke risk score for 57% of respondents; CHADS2 for 22%; and, CHADS65 for 17%. To determine the risk of bleeding, the HASBLED score was most often used (52%), but 48% of respondents indicated that they did not use a bleeding risk score. In the presence of atrial fibrillation, antithrombotic therapy choice varied widely. Our survey shows that DAPT is the most common discharge regimen after TAVR in current practice. However, the choice a...
Source: Canadian Journal of Cardiology - Category: Cardiology Source Type: research