Should Clopidogrel Be Added to Anticoagulation After TAVI?

In patients requiring oral anticoagulation, clopidogrel increased bleeding without a reduction in ischemic events.

The POPular TAVI trial (NCT02247128) is a randomized, open-label European trial of oral anticoagulation (OAC) with a vitamin K antagonist (VKA) or direct oral anticoagulant (DOAC), with or without clopidogrel, for 3 months in patients undergoing transcatheter aortic-valve implantation (TAVI). A new report focuses on the cohort of 326 patients (mean age, 81) with an established indication for OAC (95% had atrial fibrillation).

Severe bleeding of any type at 1 year occurred in 22% of patients receiving OAC alone versus 35% of those receiving OAC and clopidogrel (risk ratio, 0.63; P=0.01). Most bleeding occurred early in the postprocedure period (RR at 1 month, 0.60). The TAVI access site was the most common location for bleeding, but non–proce…

Reviewing Author

Howard C. Herrmann, MD

Disclosures

Consultant/Advisory BoardAffluent Medical; Artedrone; Caranx; Johnson & Johnson; Medtronic; Prolifagen; Wells Fargo

EquityMicrointerventional Devices, Inc.

RoyaltiesUniversity of Pennsylvania

Grant/Research SupportAbbott Vascular; Edwards Lifesciences; Johnson & Johnson; Medtronic

Editorial BoardsCatheterization and Cardiovascular Interventions; Journal of the American College of Cardiology; Circulation: Cardiovascular Interventions; JACC Cardiovascular Interventions; JACC Case Reports; JSCAI

Leadership Positions in Professional SocietiesHeart Valve Collaboratory (Scientific Committee Member, Chair of the Publications Committee)