According to the current treatment protocol, patients that undergo minimally invasive aortic heart valve replacements will likely receive two antiplatelet drugs that reduce the likelihood of developing dangerous blood clots. Now, a new meta-analysis study by Loyola Medicine has found that administering just one antiplatelet drug is sufficient enough to reduce the risk of life-threatening bleeding in comparison to two of these drugs. The study was published in the July issue of the American Journal of Cardiology and led by Verghese Mathew, MD, a renowned interventional cardiologist and chair of Loyola's division of cardiology.
The aortic valve is responsible for regulating blood flow from the hearts main pumping chamber, the left ventricle, to the body’s largest artery, the aorta. Aortic stenosis is caused by the narrowing of the aortic valve, which can cause chest pain and fatigue to many affected individuals, and severe symptoms can lead to heart failure and death. To replace a diseased aortic valve usually required an open heart surgery. But in 2011, a minimally invasive technique was developed to implant an artificial valve with a catheter. The technique is known as transcatheter aortic valve replacement (TAVR) where the catheter is inserted into an artery in the groin and is led up to the heat where the valve is placed.
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TAVR is commercially available in the United States. After administering TAVR, patients usually take two antiplatelets known as ‘dual-antiplatelet therapy’ to reduce the risk of developing blood clots. Commonly used antiplatelet drugs are aspirin and clopidogrel (Plavix). However, the treatments vary depending on the cardiologist assigned. Some providers prescribe their patients just one antiplatelet called the ‘mono-antiplatelet therapy’ usually when the patients have an increased concern of bleeding from the dual-antiplatelet therapy. However, in the study, Dr. Mathew and team analyzed the results of eight studies that compared mono-antiplatelet therapy to the use of dual-antiplatelet therapy. The studies examined 2,439 patients in total and in four of these studies, patients were deployed the Sapien aortic valve and in two studies, they received the CoreValve device. Finally, in two of these studies, both valves were administered. During 30 days, patients given two antiplatelet agents were 2.06 times more likely to die, 2.04 times more likely to develop life-threatening bleeding and 2.15 times more likely to undergo major vascular complications. "These data suggest a safety concern with dual-antiplatelet therapy and underscore the need for a large randomized trial to definitely address this question," Dr. Mathew and colleagues wrote.
Source: Loyola University Health System