PMID- 31466616
OWN - NLM
STAT- MEDLINE
DCOM- 20200514
LR  - 20200514
IS  - 1558-3597 (Electronic)
IS  - 0735-1097 (Linking)
VI  - 74
IP  - 9
DP  - 2019 Sep 3
TI  - Anticoagulation After Surgical or Transcatheter Bioprosthetic 
      Aortic Valve Replacement.
PG  - 1190-1200
LID - S0735-1097(19)35840-1 [pii]
LID - 10.1016/j.jacc.2019.06.058 [doi]
AB  - BACKGROUND: There is paucity of evidence on the impact of anticoagulation (AC) 
      after bioprosthetic aortic valve replacement (AVR) on valve hemodynamics and 
      clinical outcomes. OBJECTIVES: The study aimed to assess the impact of AC after 
      bioprosthetic AVR on valve hemodynamics and clinical outcomes. METHODS: Data on 
      antiplatelet and antithrombotic therapy were collected. Echocardiograms were 
      performed at 30 days and 1 year post-AVR. Linear regression model and 
      propensity-score adjusted cox proportional model were used to assess the impact 
      of AC on valve hemodynamics and clinical outcomes, respectively. RESULTS: A total 
      of 4,832 patients undergoing bioprosthetic AVR (transcatheter aortic valve 
      replacement [TAVR], n = 3,889 and surgical AVR [SAVR], n = 943) in the pooled 
      cohort of PARTNER2 (Placement of Aortic Transcatheter Valves) randomized trials 
      and nonrandomized registries were studied. Following adjustment for valve size, 
      annular diameter, atrial fibrillation, and ejection fraction at the time of 
      assessment of hemodynamics, there was no significant difference in aortic valve 
      mean gradients or aortic valve areas between patients discharged on AC vs. those 
      not discharged on AC, for either TAVR or SAVR cohorts. A significantly greater 
      proportion of patients not discharged on AC had an increase in mean 
      gradient >10 mm Hg from 30 days to 1 year, compared with those discharged on AC 
      (2.3% vs. 1.1%, p = 0.03). There was no independent association between AC after 
      TAVR and adverse outcomes (death, p = 0.15; rehospitalization, p = 0.16), whereas 
      AC after SAVR was associated with significantly fewer strokes (hazard ratio [HR]: 
      0.17; 95% confidence interval [CI]: 0.05-0.60; p = 0.006). CONCLUSIONS: In the 
      short term, early AC after bioprosthetic AVR did not result in adverse clinical 
      events, did not significantly affect aortic valve hemodynamics (aortic valve 
      gradients or area), and was associated with decreased rates of stroke after SAVR 
      (but not after TAVR). Whether early AC after bioprosthetic AVR has impact on 
      long-term outcomes remains to be determined. (Placement of AoRTic TraNscathetER 
      Valves [PARTNERII A]; NCT01314313).
CI  - Copyright (c) 2019. Published by Elsevier Inc.
FAU - Chakravarty, Tarun
AU  - Chakravarty T
AD  - Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
FAU - Patel, Akshar
AU  - Patel A
AD  - Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
FAU - Kapadia, Samir
AU  - Kapadia S
AD  - Cleveland Clinic, Cleveland, Ohio.
FAU - Raschpichler, Matthias
AU  - Raschpichler M
AD  - Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
FAU - Smalling, Richard W
AU  - Smalling RW
AD  - University of Texas Health Science Center at Houston, Houston, Texas.
FAU - Szeto, Wilson Y
AU  - Szeto WY
AD  - University of Pennsylvania, Philadelphia, Pennsylvania.
FAU - Abramowitz, Yigal
AU  - Abramowitz Y
AD  - Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
FAU - Cheng, Wen
AU  - Cheng W
AD  - Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
FAU - Douglas, Pamela S
AU  - Douglas PS
AD  - Duke University Medical Center/Duke Clinical Research Institute, Durham, North 
      Carolina.
FAU - Hahn, Rebecca T
AU  - Hahn RT
AD  - Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New 
      York, New York.
FAU - Herrmann, Howard C
AU  - Herrmann HC
AD  - University of Pennsylvania, Philadelphia, Pennsylvania.
FAU - Kereiakes, Dean
AU  - Kereiakes D
AD  - The Christ Hospital, Cincinnati, Ohio.
FAU - Svensson, Lars
AU  - Svensson L
AD  - Cleveland Clinic, Cleveland, Ohio.
FAU - Yoon, Sung-Han
AU  - Yoon SH
AD  - Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
FAU - Babaliaros, Vasilis C
AU  - Babaliaros VC
AD  - Emory University, Atlanta, Georgia.
FAU - Kodali, Susheel
AU  - Kodali S
AD  - Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New 
      York, New York.
FAU - Thourani, Vinod H
AU  - Thourani VH
AD  - Medstar Heart & Vascular Institute, Washington Hospital Center, Washington, DC.
FAU - Alu, Maria C
AU  - Alu MC
AD  - Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New 
      York, New York.
FAU - Liu, Yangbo
AU  - Liu Y
AD  - Cardiovascular Research Foundation, New York, New York.
FAU - McAndrew, Thomas
AU  - McAndrew T
AD  - Cardiovascular Research Foundation, New York, New York.
FAU - Mack, Michael
AU  - Mack M
AD  - Baylor Scott & White Health, Plano, Texas.
FAU - Leon, Martin B
AU  - Leon MB
AD  - Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New 
      York, New York; Cardiovascular Research Foundation, New York, New York.
FAU - Makkar, Raj R
AU  - Makkar RR
AD  - Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California. 
      Electronic address: makkarr@cshs.org.
LA  - eng
SI  - ClinicalTrials.gov/NCT01314313
PT  - Journal Article
PT  - Multicenter Study
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - J Am Coll Cardiol
JT  - Journal of the American College of Cardiology
JID - 8301365
RN  - 0 (Anticoagulants)
SB  - IM
CIN - J Am Coll Cardiol. 2019 Sep 3;74(9):1201-1204. PMID: 31466617
MH  - Aged
MH  - Aged, 80 and over
MH  - Anticoagulants/*pharmacology/therapeutic use
MH  - Aortic Valve/*drug effects/*physiology/surgery
MH  - *Bioprosthesis
MH  - Female
MH  - *Heart Valve Prosthesis
MH  - Heart Valve Prosthesis Implantation/*methods
MH  - Hemodynamics/*drug effects
MH  - Humans
MH  - Male
MH  - Postoperative Period
MH  - Prospective Studies
MH  - Transcatheter Aortic Valve Replacement
MH  - Treatment Outcome
OTO - NOTNLM
OT  - anticoagulation
OT  - bioprosthetic aortic valve replacement
OT  - transcatheter aortic valve replacement
EDAT- 2019/08/31 06:00
MHDA- 2020/05/15 06:00
CRDT- 2019/08/31 06:00
PHST- 2018/08/28 00:00 [received]
PHST- 2019/06/16 00:00 [revised]
PHST- 2019/06/18 00:00 [accepted]
PHST- 2019/08/31 06:00 [entrez]
PHST- 2019/08/31 06:00 [pubmed]
PHST- 2020/05/15 06:00 [medline]
AID - S0735-1097(19)35840-1 [pii]
AID - 10.1016/j.jacc.2019.06.058 [doi]
PST - ppublish
SO  - J Am Coll Cardiol. 2019 Sep 3;74(9):1190-1200. doi: 10.1016/j.jacc.2019.06.058.