Bleeding and thrombotic risk of different antiplatelet regimens posttranscatheter edge‐to‐edge mitral valve repair in patients with an indication for oral anticoagulation: Results from an all‐comers national registry

• Published in: Catheterization and cardiovascular interventions 2024-02, Vol.103 (2), p.382-388
• Main Authors: Claeys, Marc J., Aminian, Adel, Bartunek, Jozef, Bennett, Johan, Buysschaert, Ian, Claeys, Mathias, De Bock, Dina, Delodder, Lies, Debonnaire, Philippe, Dewilde, Willem, Ferdinande, Bert, Geerinck, Stéphanie, Goetschalckx, Kaatje, Lambrechts, Olivier, Lochy, Stijn, Paelinck, Bernard P., Rosseel, Liesbeth, Stroobants, Didier, Vanderheyden, Marc, Van der Heyden, Jan, Verbrugghe, Peter, Verheye, Stefan, Dubois, Christophe
• Format: Article
• Language: English
• Subjects: Anticoagulants - adverse effects; Antiplatelet therapy; antithrombotic therapy; Aspirin; Bleeding; Cerebral infarction; Clopidogrel; Fibrinolytic Agents - adverse effects; Hemorrhage - chemically induced; Humans; MitraClip; Mitral valve; Mitral Valve - diagnostic imaging; Mitral Valve - surgery; mitral valve repair; Myocardial infarction; Platelet Aggregation Inhibitors - adverse effects; Registries; thrombosis; Thrombosis - etiology; Thrombosis - prevention & control; Treatment Outcome
• ISSN: 1522-1946; 1522-726X
• DOI: 10.1002/ccd.30931

Background Evidence‐based recommendations for antithrombotic treatment in patients who have an indication for oral anticoagulation (OAC) after transcatheter edge‐to‐edge mitral valve repair (TEER) are lacking. Aims To compare bleeding and thrombotic risk for different antithrombotic regimens post‐TEER with MitraClip in an unselected population with the need for OACs. Methods Bleeding and thrombotic complications (stroke and myocardial infarction) up to 3 months after TEER with mitraclip were evaluated in 322 consecutive pts with an indication for OACs. These endpoints were defined by the Mitral Valve Academic Research Consortium criteria and were compared between two antithrombotic regimens: single antithrombotic therapy with OAC (single ATT) and double/triple ATT with a combination of OAC and aspirin and/or clopidogrel (combined ATT). Results Collectively, 108 (34%) patients received single ATT, 203 (63%) received double ATT and 11 (3%) received triple ATT. Bleeding events occurred in 67 patients (20.9%), with access site related events being the most frequent cause (37%). Bleeding complications were observed more frequently in the combined ATT group than in the single ATT group: 24% versus 14% [p = 0.03, adjusted RR: 0.55 (0.3–0.98)]. Within the combined group, the bleeding risk was 23% in the double ATT and 45% in the triple ATT group. Thrombotic complications occurred in only three patients (0.9%), and all belonged to the combined ATT group. Conclusions In patients with an indication for OACs, withholding of antiplatelet therapy post‐TEER with Mitraclip was associated with a 45% reduction in bleeding and without a signal of increased thrombotic risk.