For TAVR patients with AFib, antiplatelet medication linked to poorer outcomes
Oral anticoagulation medication can help minimize bleeding complications among AFib patients undergoing transcatheter aortic valve replacement (TAVR), according to new research out of Europe. When those patients are also prescribed antiplatelet medication, however, it can increase their risk of complications.
The findings were presented Sunday, March 29, at the American College of Cardiology’s Annual Scientific Session Together with World Congress of Cardiology (ACC.20/WCC) and published in the New England Journal of Medicine.
“The rates of complications for TAVR—especially complications related to bleeding—remain high,” lead author Vincent Nijenhuis, MD, a cardiologist at St. Antonius Hospital in the Netherlands, said in a statement. “This study helps physicians to better understand the risks of adding antiplatelet therapy to oral anticoagulants—namely, that doing so leads to more bleeding without reducing the rate of ischemic events. I think once physicians are aware of this, they will not treat patients undergoing TAVR so aggressively, leading to better outcomes.”
Nijenhuis et al. evaluated 313 patients with AFib who underwent TAVR at one of 17 locations in Europe. While half of the participants took oral anticoagulants alone, the other half took the anticoagulants and clopidogrel, an antiplatelet medication. After one year, the team found, patients who took the anticoagulants alone were “significantly less likely” to suffer bleeding complications. While bleeding occurred in 21.7% of patients receiving anticoagulants alone, it was observed in 34.6% of patients also taking clopidogrel. Most bleeding “occurred in the first month and was minor.”
The team also found that the patients taking anticoagulants alone were not at an increased risk of complications due to clotting. Overall, a composite of CV death, ischemic stroke and heart attack occurred in 13.4% of patients taking the anticoagulants alone and 17.3% of patients also taking clopidogrel.
“The results suggest it would be beneficial to not give clopidogrel—in fact, it’s safer because it does not lead to as many bleeding events,” Nijenhuis said.
Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.