One antiplatelet drug after heart valve replacement

August 14, 2018, Loyola University Health System

Current treatment guidelines say patients who undergo minimally invasive aortic heart valve replacements should receive two antiplatelet drugs to reduce the risk of dangerous blood clots.

A new Loyola Medicine study has found that giving a single antiplatelet drug may work as well as giving two drugs, with significantly lower risks of life-threatening bleeding and other complications.

The meta-analysis by senior author Verghese Mathew, MD, and colleagues is published in the July, 2018 issue of the American Journal of Cardiology (published online March 28). Dr. Mathew, an internationally known interventional cardiologist, is chair of Loyola's division of cardiology.

The aortic valve regulates blood flow from the left ventricle (the heart's main pumping chamber) to the aorta (the body's largest artery). Narrowing of the aortic valve, known as aortic stenosis, can cause fatigue, chest pain and other symptoms and lead to heart failure and death.

Replacing a diseased aortic valve traditionally required open heart surgery. Since 2011, a minimally invasive technique to implant an artificial valve with a catheter has been commercially available in the United States. The technique is called transcatheter (TAVR). The catheter typically is inserted into an artery in the groin and guided up to the heart, where the valve is deployed.

To reduce the risk of clots that may form on the new valve, cardiologists prescribe antiplatelet drugs. Such medications stop blood cells called platelets from sticking together and forming clots, which can cause heart attacks and strokes. Among the most commonly used antiplatelets are aspirin and clopidogrel (Plavix).

Current guidelines recommend TAVR patients receive two antiplatelets, known as dual-antiplatelet therapy. However, treatments vary. Some cardiologists prescribe just one antiplatelet, known as mono-antiplatelet therapy. Mono-antiplatelet therapy usually is prescribed in certain patients if there's an increased concern of bleeding from using two drugs.

In the new study, Dr. Mathew and colleagues pooled results of eight previous studies that compared mono-antiplatelet therapy to dual-antiplatelet therapy. The studies included 2,439 patients. In four studies, patients received the Sapien . In two studies, they received the CoreValve device. In two studies, both valves were used.

At 30 days, patients who received two antiplatelet agents were 2.06 times more likely to die, 2.04 times more likely to have major or life-threatening bleeding and 2.15 times more likely to have major vascular complications. But there were no statistically significant differences between the single-drug and dual-drug groups in stroke, heart attack or transient ischemic attack (mini stroke).

"These data suggest a safety concern with dual- and underscore the need for a large randomized trial to definitely address this question," Dr. Mathew and colleagues wrote.

The study did not include TAVR patients who required anticoagulants such as warfarin (Coumadin) or newer direct oral anticoagulants (DOACS) for other indications that increase the risk of blood clots, such as atrial fibrillation. In such cases, adding increases the risk of bleeding.

Numerous ongoing prospective studies are designed to determine which regimen achieves the best balance between clotting risk and bleeding risk after TAVR.

The Loyola study is titled, "Meta-analysis of Studies Comparing Dual- Versus Mono-Antiplatelet Therapy Following Transcatheter Aortic Valve Implantation."

Explore further: CT scans reveal reduced leaflet motion after aortic valve replacement

More information: Shadi Al Halabi et al, Meta-Analysis of Studies Comparing Dual- Versus Mono-Antiplatelet Therapy Following Transcatheter Aortic Valve Implantation, The American Journal of Cardiology (2018). DOI: 10.1016/j.amjcard.2018.03.019

Related Stories

CT scans reveal reduced leaflet motion after aortic valve replacement

March 20, 2017
About 12 percent of patients undergoing aortic valve replacement developed non-symptomatic blood clots around the valve leaflets (known as subclinical leaflet thrombosis) that reduced the motion of the valves, according to ...

New technique makes heart valve replacement safer for some high-risk patients

April 2, 2018
Scientists have developed a novel technique that prevents coronary artery obstruction during transcatheter aortic valve replacement (TAVR), a rare but often fatal complication. The method, called Bioprosthetic Aortic Scallop ...

Study: AHA guidelines to treating patients with coronary artery disease

June 27, 2017
The most recent dual antiplatelet guidelines from the American Heart Association and the American College of Cardiology encourage healthcare providers to take a customized approach to treating patients with coronary artery ...

Study examines use, outcomes of valve replacement procedure performed for off-label indications

June 21, 2017
Approximately 1 in 10 transcatheter aortic valve replacement (TAVR) procedures in the U.S. were for an off-label indication, with similar 1-year mortality rates compared to on-label use, suggesting that TAVR may be a possible ...

Increased risk of bleeding with combined use of SSRIs and antiplatelet therapy after heart attacks

September 26, 2011
Heart attack patients taking selective serotonin reuptake inhibitors (SSRIs) in combination with antiplatelet therapy -- acetylsalicylic acid (ASA), clopidogrel or both (dual antiplatelet therapy) -- are at higher risk of ...

FDA: improved artificial heart valve approved

June 19, 2015
(HealthDay)—The newest version of the Sapien 3 Transcatheter Heart Valve has been approved by the U.S. Food and Drug Administration.

Recommended for you

Study reveals a promising alternative to corticosteroids in acute renal failure treatment

September 21, 2018
A protein produced by the human body appears to be a promising new drug candidate to treat conditions that lead to acute renal failure. This is shown by a study conducted at São Paulo State University (UNESP) in São José ...

Can a common heart condition cause sudden death?

September 20, 2018
About one person out of 500 has a heart condition known as hypertrophic cardiomyopathy (HCM). This condition causes thickening of the heart muscle and results in defects in the heart's electrical system. Under conditions ...

New drugs could reduce risk of heart disease when added to statins

September 20, 2018
New drugs that lower levels of triglycerides (a type of fat) in blood could further reduce the risk of heart attack when added to statins. These new drugs, which are in various stages of development, could also reduce blood ...

Mediterranean-style diet may lower women's stroke risk

September 20, 2018
Following a Mediterranean-style diet may reduce stroke risk in women over 40 but not in men—according to new research led by the University of East Anglia.

Inflammation critical for preventing heart attacks and strokes, study reveals

September 19, 2018
Inflammation, long considered a dangerous contributor to atherosclerosis, actually plays an important role in preventing heart attacks and strokes, new research from the University of Virginia School of Medicine reveals.

People who walk just 35 minutes a day may have less severe strokes

September 19, 2018
People who participate in light to moderate physical activity, such as walking at least four hours a week or swimming two to three hours a week, may have less severe strokes than people who are physically inactive, according ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.