Can TAVI patients receive aspirin monotherapy as patients after surgical aortic bioprosthesis implantation? Data from the Polish Registry - POL-TAVI

Background: This observational analysis investigated in-hospital safety and efficacy of periprocedural antithrombotic/antiplatelet therapy used in TAVI patients included into the Polish Nationwide Cardiac Surgical and Cardiology Registry of Transcatheter Aortic Valve Implantation (POL-TAVI). Methods and results: All patients who underwent TAVI in the participating centers between 2013 and 2014 were included. The primary endpoints were: severe bleeding, vascular complications, thromboembolic events, myocardial infarction, 30-days mortality, defined according to Valve Academic Research Consortium scale 2. A total of 827 patients were included; 35-93 years old (79.31 +/- 7.53); 457 (55.29%) women. Endpoints noted: severe bleeding -130 (15.72%) pts, vascular complications -135 (16.32%) pts, thromboembolic events -29 (3.5%) pts, myocardial infarction -24 (2.90%) pts, deaths -58 (7.01%) pts. Aspirin premedication, resulted in the least number of vascular complications (OR 0.56 95% CI [0.345-0.938]; p = 0.027). Aspirin after TAVI reduced the risk of vascular complications (OR 0.089 95% CI [0.0217-0.372]; p = 0.001) and bleeding (OR 0.138 95% CI [0.043-0.447]; p = 0.001) with no adverse impact on efficacy endpoints. Beneficial safety profile of postprocedural aspirin monotherapy remained significant in comparison to all other types of prophylaxis also in propensity score analysis: OR 0.068 95% CI[0.009-0.529]; p = 0.01 for vascular complications, OR 0.176 95% CI [0.049-0.627]; p = 0.007 for bleeding. NNT for vascular complications and bleeding with postprocedural aspirin prophylaxis was 5.5 and 6.42, respectively. Conclusion: Aspirin after TAVI appears to be beneficial than currently recommended dual antiplatelet therapy; therefore, it might be considered as TAVI antithrombotic prophylaxis. (C) 2016 Elsevier Ireland Ltd. All rights reserved.