Key result
Ticagrelor significantly lowers platelet reactivity compared to clopidogrel across all time points after TAVI.
Why the study?
Although ticagrelor is more effective than clopidogrel at suppressing high platelet reactivity in aortic stenosis patients undergoing TAVI, the influence of implanted valve type on post-TAVI platelet reactivity remained to be assessed.
Does the implanted transcatheter valve type and antiplatelet regimen (ticagrelor vs clopidogrel with aspirin) influence platelet reactivity after TAVI in patients with aortic stenosis?
RCT (n=68)
Patients with high platelet reactivity (n = 48) were randomized to aspirin and clopidogrel or aspirin and ticagrelor
Yes
Does the implanted transcatheter valve type and antiplatelet regimen (ticagrelor vs clopidogrel with aspirin) influence platelet reactivity after TAVI in patients with aortic stenosis?
Transcatheter valve type (balloon-expandable vs self-expandable) does not significantly affect post-TAVI platelet reactivity, whereas ticagrelor provides faster and more effective platelet reactivity suppression than clopidogrel regardless of valve type.
Answers are grounded in this paper and cite their sources.
Supports preferring ticagrelor to clopidogrel after TAVI; confirms platelet reactivity unaffected by valve type.
OBJECTIVES: Ticagrelor has proven more effective than clopidogrel at attaining a maintained suppression of high platelet reactivity (HPR) in aortic stenosis patients undergoing transcatheter aortic valve implantation (TAVI). This study aims to assess the influence of implanted valve type on the degree of platelet reactivity (PR) after TAVI. METHODS: This study is a prespecified analysis of REAC-TAVI, a prospective, multicenter study that included patients on dual-antiplatelet therapy with aspirin and clopidogrel before TAVI. Patients with HPR (n = 48) were randomized to aspirin and clopidogrel or aspirin and ticagrelor for 3 months, while those without HPR (n = 20) were continued on aspirin and clopidogrel. PR was measured 6 hours, 24 hours, 5 days, 30 days, and 90 days after TAVI with VerifyNow assay. Bioprosthetic valves were classified as balloon-expandable valve (BEV), self-expandable valve (SEV), or other. RESULTS: Sixty-eight patients comprising 32 BEVs, 28 SEVs, and 8 other valves were included. Devices were larger and postdilation was more frequent in the SEV group. Follow-up PR was lower in patients treated with ticagrelor vs those treated with clopidogrel at all time points after TAVI, including patients without baseline HPR (P<.001). PR after TAVI was similar in the three groups. Major cardiovascular adverse events, stroke, and hemorrhagic complications were comparable across the different bioprosthesis groups at 4-month follow-up. CONCLUSIONS: The effect of valve type on PR after TAVI is similar across the spectrum of most transcatheter valves. In our sample, ticagrelor achieved a faster and more effective reduction in PR than clopidogrel in patients with HPR undergoing TAVI, irrespective of valve type.
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Trejo‐Velasco et al. (2020) conducted an RCT in Aortic stenosis undergoing transcatheter aortic valve implantation (TAVI) (n=68). Aspirin and ticagrelor, and implanted valve type (balloon-expandable vs self-expandable vs other) vs. Aspirin and clopidogrel was evaluated on Degree of platelet reactivity (PR) measured at 6 hours, 24 hours, 5 days, 30 days, and 90 days after TAVI with VerifyNow assay (p=<.001). Ticagrelor lowered follow-up platelet reactivity vs clopidogrel at all time points after TAVI, while platelet reactivity was similar across balloon-expandable and self-expandable valves.
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