期刊
JACC-CARDIOVASCULAR INTERVENTIONS
卷 16, 期 9, 页码 1095-1102出版社
ELSEVIER SCIENCE INC
DOI: 10.1016/j.jcin.2023.02.039
关键词
antiplatelet therapy; bleeding; oral anticoagulants; sex differences; TAVR
This study compared the occurrence of bleeding and ischemic complications after TAVR between women and men under different antiplatelet and oral anticoagulant regimens. The results showed that women had a higher incidence of major or life-threatening bleeding, particularly when taking aspirin.
BACKGROUND Stroke and bleeding are complications after transcatheter aortic valve replacement (TAVR). A higher incidence of bleeding and stroke has been reported in women, but the role of antithrombotic management pre-and post-TAVR has not been studied.OBJECTIVES The study sought to compare bleeding and ischemic complications after TAVR between women and men stratified by antiplatelet and oral anticoagulant (OAC) regimen.METHODS The POPular TAVI (Antiplatelet Therapy for Patients Undergoing Transcatheter Aortic Valve Implantation) trial was a randomized clinical trial to test the hypothesis that monotherapy with aspirin or OAC after TAVR is safer than the addition of clopidogrel. The primary endpoints of interest of this post hoc subanalysis were: 1) all bleeding; and 2) a composite of ischemic events consisting of stroke and myocardial infarction. Secondary endpoints were: 1) nonprocedural bleeding; 2) major or life-threatening bleeding; 3) minor bleeding; 4) stroke; 5) myocardial infarction; and 6) all-cause death.RESULTS A total of 978 patients (466 [47.6%] women) were included in this study. All bleeding and the composite of myocardial infarction and stroke rates were similar between sexes (all bleeding: 106 [22.8%] women vs 121 [23.6%] men; P = 0.815; ischemic events: 26 [5.6%] vs 36 [7.0%]; P = 0.429). However, major or life-threatening bleeding occurred more often in women (58 [12.5%]) vs men (38 [7.4%]) (P = 0.011), most of which were access site bleedings. The use of aspirin pre-and post-TAVR increased major or life-threatening bleeding in women but not in men.CONCLUSIONS After TAVR, overall bleeding and ischemic outcomes were similar between women and men. However, women had more major or life-threatening bleedings, especially those receiving aspirin pre-and post-TAVR. (J Am Coll Cardiol Intv 2023;16:1095-1102) & COPY; 2023 by the American College of Cardiology Foundation.
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