Association Between Transcatheter Aortic Valve Replacement and Early Postprocedural Stroke
Why the study?
Reducing postprocedural stroke is important to improve TAVR safety, prompting evaluation of 30-day stroke trends, its link to mortality, and medical therapy associations during the first 5 years of US use.
Does antithrombotic medical therapy at discharge reduce postdischarge 30-day stroke risk in patients undergoing TAVR?
Population
101 430 patients treated with femoral and nonfemoral TAVR at 521 US hospitals
Comparison
Antithrombotic medical therapies vs no therapy at hospital discharge
Design
Retrospective cohort study
Follow-up
30 days
Authors
Discussion
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Member takes
Implication
Discharge antithrombotics showed no association with 30-day stroke risk after TAVR; leaves open optimal regimens pending randomized trials.
Structured PICO
Does antithrombotic medical therapy at discharge reduce postdischarge 30-day stroke risk in patients undergoing TAVR?
P
Population
101,430 patients treated with femoral and nonfemoral transcatheter aortic valve replacement (TAVR) at 521 US hospitals in the STS/ACC TVT Registry from November 2011 through May 2017, median age 83 years, 47.1% women.
I
Intervention
Transcatheter aortic valve replacement (TAVR) with subsequent discharge on dual antiplatelet therapy or oral anticoagulant therapy
C
Comparator
No dual antiplatelet therapy or no oral anticoagulant therapy at discharge
O
Outcome
Rates of 30-day transient ischemic attack and strokehard clinical
The 30-day stroke rate following TAVR remained stable at 2.3% between 2011 and 2017, was strongly associated with increased 30-day mortality, and was not influenced by discharge antithrombotic therapy.
Cite This Study
Huded et al. (2019) studied this question.