Course of early subclinical leaflet thrombosis after transcatheter aortic valve implantation with or without oral anticoagulation

• Published in: Clinical research in cardiology 2017-02, Vol.106 (2), p.85-95
• Main Authors: Ruile, Philipp, Jander, Nikolaus, Blanke, Philipp, Schoechlin, Simon, Reinöhl, Jochen, Gick, Michael, Rothe, Juergen, Langer, Mathias, Leipsic, Jonathon, Buettner, Heinz-Joachim, Neumann, Franz-Josef, Pache, Gregor
• Format: Article
• Language: English
• Subjects: Administration, Oral; Aged; Aged, 80 and over; Anticoagulants - administration & dosage; Aortic Valve - diagnostic imaging; Aortic Valve - drug effects; Aortic Valve - physiopathology; Aortic Valve Stenosis - diagnostic imaging; Aortic Valve Stenosis - physiopathology; Aortic Valve Stenosis - therapy; Cardiac Catheterization - adverse effects; Cardiac Catheterization - instrumentation; Cardiac Catheterization - methods; Cardiology; Drug Administration Schedule; Female; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation - adverse effects; Heart Valve Prosthesis Implantation - instrumentation; Heart Valve Prosthesis Implantation - methods; Hemodynamics; Humans; Male; Medicine; Medicine & Public Health; Original Paper; Phenprocoumon - administration & dosage; Platelet Aggregation Inhibitors - administration & dosage; Prospective Studies; Registries; Risk Factors; Thrombosis - diagnosis; Thrombosis - etiology; Thrombosis - prevention & control; Time Factors; Tomography, X-Ray Computed; Treatment Outcome
• ISSN: 1861-0684; 1861-0692
• DOI: 10.1007/s00392-016-1052-3

Background After transcatheter aortic valve implantation, early leaflet thickening, presumably reflecting thrombus, has recently been described on computed tomography angiography (CTA) in ~10% of the patients. We sought to investigate the impact of the antithrombotic regimen on the course of leaflet thickening. Methods The study comprised 51 patients with leaflet thickening. Based on the time period, patients without an established indication for anticoagulation were put on phenprocoumon plus clopidogrel for at least 3 months or on dual antiplatelet therapy with aspirin and clopidogrel. Follow-up CTAs were evaluated for leaflet restriction, assessed by four-point-grading score, and maximal thickness. Findings The anticoagulation and the dual antiplatelet therapy group comprised 29 and 22 patients, respectively. After a median of 86 days, we obtained follow-up CTAs in 22 patients on anticoagulation and in 16 patients on dual antiplatelet therapy. Leaflet thickening progressed in 11 on dual antiplatelet therapy, but always regressed onanticoagulation. The course of leaflet restriction and maximal thickness was significantly different between the two groups ( P