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Antithrombotic Treatment and Its Association with Outcome in a Multicenter Cohort of Transcatheter Edge-to-Edge Mitral Valve Repair Patients

Transcatheter edge-to-edge mitral valve repair (TEER) has become established as a safe and efficacious therapy for severe mitral regurgitation (MR) in high-risk patients. Despite its widespread use, postprocedural antithrombotic therapy (ATT) still to date is based on local expertise rather than evi...

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Autores principales: Waechter, Christian, Ausbuettel, Felix, Chatzis, Georgios, Cheko, Juan, Fischer, Dieter, Nef, Holger, Barth, Sebastian, Halbfass, Philipp, Deneke, Thomas, Mueller, Julian, Kerber, Sebastian, Divchev, Dimitar, Schieffer, Bernhard, Luesebrink, Ulrich
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9695441/
https://www.ncbi.nlm.nih.gov/pubmed/36354765
http://dx.doi.org/10.3390/jcdd9110366
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author Waechter, Christian
Ausbuettel, Felix
Chatzis, Georgios
Cheko, Juan
Fischer, Dieter
Nef, Holger
Barth, Sebastian
Halbfass, Philipp
Deneke, Thomas
Mueller, Julian
Kerber, Sebastian
Divchev, Dimitar
Schieffer, Bernhard
Luesebrink, Ulrich
author_facet Waechter, Christian
Ausbuettel, Felix
Chatzis, Georgios
Cheko, Juan
Fischer, Dieter
Nef, Holger
Barth, Sebastian
Halbfass, Philipp
Deneke, Thomas
Mueller, Julian
Kerber, Sebastian
Divchev, Dimitar
Schieffer, Bernhard
Luesebrink, Ulrich
author_sort Waechter, Christian
collection PubMed
description Transcatheter edge-to-edge mitral valve repair (TEER) has become established as a safe and efficacious therapy for severe mitral regurgitation (MR) in high-risk patients. Despite its widespread use, postprocedural antithrombotic therapy (ATT) still to date is based on local expertise rather than evidence. In a multicenter, observational cohort study, 646 consecutive patients undergoing TEER were enrolled; 609 patients were successfully treated and antithrombotic therapy analyzed; 449 patients (73.7%) were previously treated with oral anticoagulants (OAC) due to the high prevalence of atrial fibrillation (459/609, 75.4%). Postprocedural ATT in patients previously treated with OAC consisted of no additional, additional single (SAPT) or dual antiplatelet therapy (DAPT) in 146/449 (33.6%), 248/449 (55.2%) and 55/449 (12.2%), respectively. There were 234/449 (52.1%) patients treated with vitamin-k antagonists (VKA) and 215/449 (47.9%) with nonvitamin-k antagonist oral anticoagulants (NOAC). One hundred sixty patients (26.3%) had no prior indication for OAC and were predominantly treated with DAPT (132/160, 82.5%). Use of SAPT (17/160, 10.6%) and no APT (11/160, 6.9%) was marginal. No statistically significant differences in terms of in-hospital mortality or the rate of major adverse cardiac and cerebrovascular events (MACCE) between the different antithrombotic therapy regimens were observed. Multiple Cox regression analysis showed a statistically significant decreased risk for all-cause mortality after a median follow-up of 419 days for OAC monotherapy (HR 0.6, 95%-CI 0.5–0.9, p = 0.04). This study provides evidence for a more favorable long-term outcome of OAC monotherapy in patients with an indication for OAC and reiterates the urgent need for randomized controlled trials on the optimal antithrombotic treatment of TEER patients.
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spelling pubmed-96954412022-11-26 Antithrombotic Treatment and Its Association with Outcome in a Multicenter Cohort of Transcatheter Edge-to-Edge Mitral Valve Repair Patients Waechter, Christian Ausbuettel, Felix Chatzis, Georgios Cheko, Juan Fischer, Dieter Nef, Holger Barth, Sebastian Halbfass, Philipp Deneke, Thomas Mueller, Julian Kerber, Sebastian Divchev, Dimitar Schieffer, Bernhard Luesebrink, Ulrich J Cardiovasc Dev Dis Article Transcatheter edge-to-edge mitral valve repair (TEER) has become established as a safe and efficacious therapy for severe mitral regurgitation (MR) in high-risk patients. Despite its widespread use, postprocedural antithrombotic therapy (ATT) still to date is based on local expertise rather than evidence. In a multicenter, observational cohort study, 646 consecutive patients undergoing TEER were enrolled; 609 patients were successfully treated and antithrombotic therapy analyzed; 449 patients (73.7%) were previously treated with oral anticoagulants (OAC) due to the high prevalence of atrial fibrillation (459/609, 75.4%). Postprocedural ATT in patients previously treated with OAC consisted of no additional, additional single (SAPT) or dual antiplatelet therapy (DAPT) in 146/449 (33.6%), 248/449 (55.2%) and 55/449 (12.2%), respectively. There were 234/449 (52.1%) patients treated with vitamin-k antagonists (VKA) and 215/449 (47.9%) with nonvitamin-k antagonist oral anticoagulants (NOAC). One hundred sixty patients (26.3%) had no prior indication for OAC and were predominantly treated with DAPT (132/160, 82.5%). Use of SAPT (17/160, 10.6%) and no APT (11/160, 6.9%) was marginal. No statistically significant differences in terms of in-hospital mortality or the rate of major adverse cardiac and cerebrovascular events (MACCE) between the different antithrombotic therapy regimens were observed. Multiple Cox regression analysis showed a statistically significant decreased risk for all-cause mortality after a median follow-up of 419 days for OAC monotherapy (HR 0.6, 95%-CI 0.5–0.9, p = 0.04). This study provides evidence for a more favorable long-term outcome of OAC monotherapy in patients with an indication for OAC and reiterates the urgent need for randomized controlled trials on the optimal antithrombotic treatment of TEER patients. MDPI 2022-10-25 /pmc/articles/PMC9695441/ /pubmed/36354765 http://dx.doi.org/10.3390/jcdd9110366 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Waechter, Christian
Ausbuettel, Felix
Chatzis, Georgios
Cheko, Juan
Fischer, Dieter
Nef, Holger
Barth, Sebastian
Halbfass, Philipp
Deneke, Thomas
Mueller, Julian
Kerber, Sebastian
Divchev, Dimitar
Schieffer, Bernhard
Luesebrink, Ulrich
Antithrombotic Treatment and Its Association with Outcome in a Multicenter Cohort of Transcatheter Edge-to-Edge Mitral Valve Repair Patients
title Antithrombotic Treatment and Its Association with Outcome in a Multicenter Cohort of Transcatheter Edge-to-Edge Mitral Valve Repair Patients
title_full Antithrombotic Treatment and Its Association with Outcome in a Multicenter Cohort of Transcatheter Edge-to-Edge Mitral Valve Repair Patients
title_fullStr Antithrombotic Treatment and Its Association with Outcome in a Multicenter Cohort of Transcatheter Edge-to-Edge Mitral Valve Repair Patients
title_full_unstemmed Antithrombotic Treatment and Its Association with Outcome in a Multicenter Cohort of Transcatheter Edge-to-Edge Mitral Valve Repair Patients
title_short Antithrombotic Treatment and Its Association with Outcome in a Multicenter Cohort of Transcatheter Edge-to-Edge Mitral Valve Repair Patients
title_sort antithrombotic treatment and its association with outcome in a multicenter cohort of transcatheter edge-to-edge mitral valve repair patients
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9695441/
https://www.ncbi.nlm.nih.gov/pubmed/36354765
http://dx.doi.org/10.3390/jcdd9110366
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