PMID- 36272571
OWN - NLM
STAT- MEDLINE
DCOM- 20221216
LR  - 20221221
IS  - 1874-1754 (Electronic)
IS  - 0167-5273 (Linking)
VI  - 371
DP  - 2023 Jan 15
TI  - Subclinical leaflet thrombosis and antithrombotic therapy post-TAVI: An LRT 
      substudy.
PG  - 305-311
LID - S0167-5273(22)01645-X [pii]
LID - 10.1016/j.ijcard.2022.10.134 [doi]
AB  - BACKGROUND: Subclinical leaflet thrombosis (SLT) is characterized on computed 
      tomography (CT) imaging as hypoattenuated leaflet thickening (HALT), reduced 
      leaflet motion (RELM), and hypoattenuation affecting motion (HAM). How 
      antithrombotic regimen type impacts SLT remains poorly understood. We evaluated 
      how antithrombotic regimen type impacts SLT in low-risk subjects following 
      transcatheter aortic valve implantation (TAVI). METHODS: This substudy is a post 
      hoc analysis of the LRT 1.0 and 2.0 trials to assess SLT in subjects who 
      underwent CT or transoesophageal echocardiogram (TOE) imaging at 30 days, 
      stratified by antithrombotic regimen received (single antiplatelet therapy 
      [SAPT], dual antiplatelet therapy [DAPT], or oral anticoagulation). We also 
      utilized univariable logistic regression modelling to identify echocardiographic 
      predictors of HALT. RESULTS: Rates of HALT, RELM, and HAM were all significantly 
      lower with oral anticoagulation compared to SAPT or DAPT at 30 days (HALT: 2.6% 
      vs 14.3% vs 17.2%, respectively, with p < 0.001; RELM: 1.8% vs 9.6% vs 13.1%, 
      respectively, with p = 0.004; and HAM: 0.9% vs 8.5% vs 9.8%, respectively, with 
      p = 0.011). Additionally, short-term oral anticoagulation was not associated with 
      higher bleeding rates compared to SAPT or DAPT (0.8% vs. 1.8% vs. 3.6%, 
      p = 0.291). The presence of HALT did not significantly impact echocardiographic 
      haemodynamic parameters at 30 days. CONCLUSION: This is the largest study to date 
      that evaluated the impact of different antithrombotic regimens on SLT in low-risk 
      TAVI patients. Oral anticoagulation was associated with significantly lower rates 
      of SLT at 30 days compared to DAPT or SAPT, and there was no apparent benefit of 
      DAPT over SAPT.
CI  - Copyright (c) 2022 Elsevier B.V. All rights reserved.
FAU - Bhogal, Sukhdeep
AU  - Bhogal S
AD  - Section of Interventional Cardiology, MedStar Washington Hospital Center, 
      Washington, DC, USA.
FAU - Waksman, Ron
AU  - Waksman R
AD  - Section of Interventional Cardiology, MedStar Washington Hospital Center, 
      Washington, DC, USA. Electronic address: ron.waksman@medstar.net.
FAU - Gordon, Paul
AU  - Gordon P
AD  - Division of Cardiology, Miriam Hospital, Providence, RI, USA.
FAU - Ehsan, Afshin
AU  - Ehsan A
AD  - Division of Cardiothoracic Surgery, Lifespan Cardiovascular Institute, 
      Providence, RI, USA.
FAU - Wilson, Sean R
AU  - Wilson SR
AD  - Department of Cardiology, North Shore University Hospital, Manhasset, NY, USA.
FAU - Levitt, Robert
AU  - Levitt R
AD  - Department of Cardiology, HCA Virginia Health System, Richmond, VA, USA.
FAU - Parikh, Puja
AU  - Parikh P
AD  - Department of Medicine, Stony Brook Hospital, Stony Brook, NY, USA.
FAU - Bilfinger, Thomas
AU  - Bilfinger T
AD  - Department of Surgery, Stony Brook Hospital, Stony Brook, NY, USA.
FAU - Hanna, Nicholas
AU  - Hanna N
AD  - St. John Heart Institute Cardiovascular Consultants, St. John Health System, 
      Tulsa, OK, USA.
FAU - Buchbinder, Maurice
AU  - Buchbinder M
AD  - Foundation for Cardiovascular Medicine, Stanford University, Stanford, CA, USA.
FAU - Asch, Federico M
AU  - Asch FM
AD  - MedStar Health Research Institute, MedStar Washington Hospital Center, 
      Washington, DC, USA.
FAU - Weissman, Gaby
AU  - Weissman G
AD  - Department of Cardiology, MedStar Washington Hospital Center, Washington, DC, 
      USA.
FAU - Ben-Dor, Itsik
AU  - Ben-Dor I
AD  - Section of Interventional Cardiology, MedStar Washington Hospital Center, 
      Washington, DC, USA.
FAU - Shults, Christian C
AU  - Shults CC
AD  - Department of Cardiac Surgery, MedStar Washington Hospital Center, Washington, 
      DC, USA.
FAU - Ali, Syed
AU  - Ali S
AD  - Section of Interventional Cardiology, MedStar Washington Hospital Center, 
      Washington, DC, USA.
FAU - Shea, Corey
AU  - Shea C
AD  - Section of Interventional Cardiology, MedStar Washington Hospital Center, 
      Washington, DC, USA.
FAU - Zhang, Cheng
AU  - Zhang C
AD  - Section of Interventional Cardiology, MedStar Washington Hospital Center, 
      Washington, DC, USA.
FAU - Garcia-Garcia, Hector M
AU  - Garcia-Garcia HM
AD  - Section of Interventional Cardiology, MedStar Washington Hospital Center, 
      Washington, DC, USA.
FAU - Satler, Lowell F
AU  - Satler LF
AD  - Section of Interventional Cardiology, MedStar Washington Hospital Center, 
      Washington, DC, USA.
FAU - Rogers, Toby
AU  - Rogers T
AD  - Section of Interventional Cardiology, MedStar Washington Hospital Center, 
      Washington, DC, USA.
LA  - eng
PT  - Journal Article
DEP - 20221020
PL  - Netherlands
TA  - Int J Cardiol
JT  - International journal of cardiology
JID - 8200291
RN  - 0 (Fibrinolytic Agents)
RN  - 0 (Platelet Aggregation Inhibitors)
SB  - IM
MH  - Humans
MH  - *Transcatheter Aortic Valve Replacement/adverse effects/methods
MH  - Fibrinolytic Agents/adverse effects
MH  - Aortic Valve/diagnostic imaging/surgery
MH  - *Heart Valve Prosthesis/adverse effects
MH  - *Thrombosis/diagnostic imaging/drug therapy/etiology
MH  - Treatment Outcome
MH  - Platelet Aggregation Inhibitors/adverse effects
MH  - *Aortic Valve Stenosis/diagnostic imaging/drug therapy/surgery
OTO - NOTNLM
OT  - Dual-antiplatelet therapy
OT  - Hypoattenuated leaflet thickening
OT  - Oral anticoagulation
OT  - Single-antiplatelet therapy
OT  - Subclinical leaflet thrombosis
COIS- Declaration of Competing Interest Ron Waksman - Advisory Board: Abbott Vascular, 
      Boston Scientific, Medtronic, Philips IGT, Pi-Cardia Ltd.; Consultant: Abbott 
      Vascular, Biotronik, Boston Scientific, Cordis, Medtronic, Philips IGT, Pi-Cardia 
      Ltd., Swiss Interventional Systems/SIS Medical AG, Transmural Systems Inc., 
      Venous MedTech; Grant Support: AstraZeneca, Biotronik, Boston Scientific, Chiesi, 
      Medtronic, Philips IGT; Speakers Bureau: AstraZeneca; Investor: MedAlliance, 
      Transmural Systems Inc. Puja Parikh - Consultant: Medtronic, Inc. Federico Asch - 
      No personal disclosures. Director of the MedStar Health Academic Echocardiography 
      Core Laboratory which has institutional contracts with Medtronic, Edwards 
      Lifesciences, Abbott, Boston Scientific, Biotronik and LivaNova. Gaby Weissman - 
      No personal disclosures. Director of an academic cardiac computed tomography core 
      lab with institutional contracts with Ancora Heart and LivaNova. Toby Rogers - 
      Proctor and Consultant: Medtronic, Edwards Lifesciences; Advisory Board: 
      Medtronic; Equity interest: Transmural Systems. All other authors have no 
      relationships with industry to disclose.
EDAT- 2022/10/23 06:00
MHDA- 2022/12/15 06:00
CRDT- 2022/10/22 19:33
PHST- 2022/07/08 00:00 [received]
PHST- 2022/09/23 00:00 [revised]
PHST- 2022/10/16 00:00 [accepted]
PHST- 2022/10/23 06:00 [pubmed]
PHST- 2022/12/15 06:00 [medline]
PHST- 2022/10/22 19:33 [entrez]
AID - S0167-5273(22)01645-X [pii]
AID - 10.1016/j.ijcard.2022.10.134 [doi]
PST - ppublish
SO  - Int J Cardiol. 2023 Jan 15;371:305-311. doi: 10.1016/j.ijcard.2022.10.134. Epub 
      2022 Oct 20.