Titre :

Reply: Oral Anticoagulant Dose Adjustment After TAVR: The Role of Closure TimeWith Adenosine Diphosphate

Auteur(s) :

Collet, Jean-Philippe [Auteur]
van Belle, Eric [Auteur]
Récepteurs Nucléaires, Maladies Métaboliques et Cardiovasculaires - U 1011 [RNMCD]
Guedeney, Paul [Auteur]
Vicaut, Eric [Auteur]
Montalescot, Gilles [Auteur]

Titre de la revue :

JACC: Cardiovascular Interventions

Pagination :

2576

Éditeur :

Elsevier/American College of Cardiology

Date de publication :

2022-12

ISSN :

1936-8798

Discipline(s) HAL :

Sciences du Vivant [q-bio]

Résumé en anglais : [en]

Next article in issue Subclinical valve thrombosis after transcatheter aortic valve replacement (TAVR) is frequent (10%) 1 and is associated with a 2-fold increase in the risk of stroke. It is not predicted by onclopidogrel ...
Lire la suite >Next article in issue Subclinical valve thrombosis after transcatheter aortic valve replacement (TAVR) is frequent (10%) 1 and is associated with a 2-fold increase in the risk of stroke. It is not predicted by onclopidogrel adenosine diphosphate (ADP)-induced platelet reactivity but can be reversed or prevented by oral anticoagulation (OAC). 2 Major bleedings are as frequent and independently associated with survival. Postprocedural low on-clopidogrel platelet reactivity and a closure time of ADP >180 seconds, a surrogate of persistent primary hemostasis disorders, predict major bleedings, 3,4 and their use for adjusting the dose of direct oral anticoagulants (DOAC) is suggested although no intervention trials have ever been performed. Trials comparing DOAC vs antiplatelet therapy (APT) failed to demonstrate any clinical benefit except a drastic reduction of subclinical valve thrombosis. In the ATLANTIS (Anti-Thrombotic Strategy to Lower All Cardiovascular and Neurologic Ischemic and Hemorrhagic Events After Trans-Aortic Valve Implantation for Aortic Stenosis) trial, the safety of apixaban (5 mg b.i.d) was similar to that of the standard of care (APT or vitamin K antagonists) although apixaban was combined with APT in 30% of patients. 5 This was not the case in the GALILEO (Global Study Comparing a Rivaroxaban-Based Antithrombotic Strategy to an Antiplatelet-Based Strategy After Transcatheter Aortic Valve Replacement to Optimize Clinical Outcomes) with a reduced dose rivaroxaban (10 mg per day) systematically combined with aspirin leading to a significant excess of major bleeding. 6 This was not the case either with edoxaban, which was associated with more major bleeding than vitamin K antagonists. 7 The bulk of evidence suggests that the type of DOAC, the dosing, and the combination with APT are essential in the safety of these drugs after TAVR. Whether platelet function monitoring may guide OAC therapy after TAVR remains a hypothesis never proven in the past by randomized clinical trials in percutaneous coronary intervention. References 1 G. Montalescot, A. Redheuil, F. Vincent, et al. Apixaban and valve thrombosis after transcatheter aortic valve replacement: the ATLANTIS-4D-CT randomized clinical trial substudy J Am Coll Cardiol Intv, 15 (2022), pp. 1794-1804 2 T.G. Nührenberg, J. Hromek, A. Kille, et al. Impact of on-clopidogrel platelet reactivity on incidence of hypoattenuated leaflet thickening after transcatheter aortic valve replacement J Am Coll Cardiol Intv, 12 (2019), pp. 12-18 3 A. Kille, K. Franke, N. Corpataux, et al. Impact of on-clopidogrel platelet reactivity on incidence of peri-interventional bleeding in patients undergoing transcatheter aortic valve implantationLire moins >

Langue :

Anglais

Comité de lecture :

Oui

Audience :

Internationale

Vulgarisation :

Non

Collections :

• Récepteurs nucléaires, Maladies Cardiovasculaires et Diabète (RNMCD) - U1011

Source :

Harvested from HAL