Personalized Antithrombotic Strategies in Patients with Atrial Fibrillation Following Transcatheter Aortic Valve Replacement
Abstract
:1. Introduction
2. Methods
2.1. Design and Patients
2.2. Data and Endpoints
2.3. Statistical Analysis
3. Results
3.1. Baseline Data
3.2. Procedure Data
3.3. Hospital Outcomes
3.4. Follow-Up Outcomes
4. Discussion
Strengths and Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Abbreviations
References
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DAPT N = 13 | DOAC Only N = 25 | Warfarin Only N = 8 | SAPT + DOAC N = 44 | SAPT + Warfarin N = 17 | Triple (DAPT + DOAC) N = 7 | Triple (DAPT + Warfarin) N = 7 | |
---|---|---|---|---|---|---|---|
Age (years) | 81 (72–87) | 76 (70–81) | 75 (68–78.5) | 75 (69–81) | 72 (68–79) | 72 (68–89) | 74 (68–80) |
Male | 9 (69.23%) | 11 (44%) | 4 (50%) | 22 (50%) | 6 (35.29%) | 5 (71.43%) | 4 (57.14%) |
Body mass index (kg/m2) | 30.82 (26.6–33.7) | 30.08 (27.5–35.1) | 28.55 (27.5–29.5) | 30.565 (26.1–36.5) | 32.88 (28.4–35.6) | 28.05 (25–33.6) | 26.54 (22.5–34.6) |
Hypertension | 10 (76.92%) | 22 (88%) | 6 (75%) | 35 (79.55%) | 14 (82.35%) | 7 (100%) | 5 (71.43%) |
Diabetes | 9 (69.23%) | 18 (72%) | 5 (62.50%) | 26 (59.09%) | 11 (64.71%) | 5 (71.43%) | 4 (57.14%) |
Dyslipidemia | 6 (46.15%) | 16 (64%) | 4 (50%) | 18 (40.91%) | 5 (29.41%) | 4 (57.14%) | 2 (28.57%) |
Hypothyroidism | 1 (7.69%) | 9 (36%) | 1 (12.50%) | 5 (11.36%) | 1 (5.88%) | 0 | 1 (14.29%) |
Anemia | 4 (30.77%) | 4 (16%) | 2 (25%) | 14 (31.82%) | 4 (23.53%) | 1 (14.29%) | 1 (14.29%) |
Dialysis | 1 (7.69%) | 0 | 0 | 1 (2.27%) | 1 (5.88%) | 0 | 0 |
Chronic Liver disease | 1 (7.69%) | 1 (4%) | 1 (12.50%) | 0 | 1 (5.88%) | 0 | 0 |
Chronic lung disease | 3 (23.08%) | 6 (24%) | 2 (25%) | 8 (18.18%) | 5 (29.41%) | 1 (14.29%) | 3 (42.86%) |
Cancer within 5 years | 1 (7.69%) | 1 (4%) | 0 | 4 (9.09%) | 1 (5.88%) | 0 | 0 |
Cerebrovascular disease | 2 (15.38%) | 0 | 1 (12.50%) | 6 (13.64%) | 3 (17.65%) | 0 | 1 (14.29%) |
Coronary artery diseases | 9 (69.23%) | 7 (28%) | 0 | 17 (38.64%) | 9 (52.94%) | 4 (57.14%) | 7 (100%) |
Prior percutaneous coronary intervention | 6 (46.15%) | 3 (12%) | 0 | 6 (13.64%) | 3 (17.65%) | 1 (14.29%) | 4 (57.14%) |
Prior coronary artery bypass graft | 1 (7.69%) | 2 (8%) | 0 | 4 (9.09%) | 2 (11.76%) | 1 (14.29%) | 1 (14.29%) |
Prior myocardial infarction (MI) | 0 | 1 (4%) | 0 | 3 (6.82%) | 0 | 0 | 2 (28.57%) |
Peripheral arterial disease | 5 (38.46%) | 1 (4%) | 0 | 4 (9.09%) | 8 (47.06%) | 0 | 0 |
Prior atrial fibrillation | 7 (53.85%) | 23 (92%) | 7 (87.50%) | 40 (90.91%) | 14 (82.35%) | 5 (71.43%) | 7 (100%) |
Permanent Pacemaker (PPM) | 0 | 0 | 1 (12.50%) | 3 (6.82%) | 0 | 0 | 2 (28.57%) |
Left ventricular ejection fraction, % | 55 (50–60) | 55 (40–55) | 52.5 (42.5–55) | 55 (45–60) | 55 (45–60) | 50 (45–55) | 45 (25–60) |
NYHA * Class I–II | 1 (7.69%) | 4 (16%) | 2 (25%) | 10 (22.7%) | 1 (5.88%) | 0 | 0 |
NYHA * Class III–IV | 12 (92.3%) | 21 (84%) | 6 (75%) | 34 (77.2%) | 16 (94.1%) | 7 (100%) | 7 (100%) |
CHA2DS2-VASc score ** | 4 (3–5) | 4 (4–5) | 4 (3–5) | 4 (3–5) | 4 (3–7) | 4 (3–5) | 4 (3–5) |
HAS-BLED score *** Score 0 | 0 | 1 (4%) | 0 | 1 (2.27%) | 0 | 0 | 0 |
Score 1–2 | 7 (53.8%) | 13 (52%) | 4 (50%) | 26 (59%) | 6 (35.3%) | 3 (42.8%) | 1 (14.3%) |
Score ≥ 3 | 6 (46.1%) | 11 (44%) | 4 (50%) | 17 (38.6) | 11 (64.7%) | 4 (57.1%) | 6 (85.7%) |
Never smoked | 5 (38.46%) | 15 (60%) | 3 (37.5%) | 11 (25%) | 7 (41.18%) | 3 (42.86%) | 4 (57.14%) |
current SMOKER, but unknown frequency | 0 | 0 | 0 | 2 (4.55%) | 1 (5.88%) | 0 | 0 |
Former smoker | 0 | 0 | 0 | 3 (6.82%) | 0 | 0 | 1 (14.29%) |
Unknown | 8 (61.54%) | 10 (40%) | 5 (62.5%) | 28 (63.64%) | 9 (52.94%) | 4 (57.14%) | 2 (28.57%) |
Creatinine Clearance (mL/min) | 44.1 (34–71.7) | 63.4 (52.9–73.1) | 67.2 (63.8–75.8) | 67.6 (52.25–98.8) | 70.6 (50.1–83.6) | 80.8 (41–87.2) | 58.9 (47.8–67.9) |
Hemoglobin (g/dL) | 12.5 (11.5–13.1) | 12 (10.8–13.8) | 13.8 (12.1–14.6) | 12.25 (10.45–13.8) | 11.7 (11.2–13.2) | 12.1 (10.8–12.8) | 12.4 (11.3–13) |
Platelet count (109/L) | 263 (229–300) | 211 (176–248) | 159 (151.5–278.5) | 263.5 (215.5–297.5) | 215 (174–274) | 274 (130–342) | 240 (237–315) |
DAPT N = 13 | DOAC Only N = 25 | Warfarin Only N = 8 | SAPT + DOAC N = 44 | SAPT + Warfarin N = 17 | Triple (DAPT + DOAC) N = 7 | Triple (DAPT + Warfarin) N = 7 | |
---|---|---|---|---|---|---|---|
Trans-femoral | 12 (92.31%) | 25 (100%) | 8 (100%) | 44 (100%) | 15 (88.24%) | 7 (100%) | 7 (100%) |
Trans-apical | 0 | 0 | 0 | 0 | 1 (5.88%) | 0 | 0 |
Trans-subclavian | 1 (7.69%) | 0 | 0 | 0 | 0 | 0 | 0 |
Direct aortic | 0 | 0 | 0 | 0 | 1 (5.88%) | 0 | 0 |
PCI | 0 | 0 | 0 | 4 (9.09%) | 0 | 3 (42.86%) | 2 (28.57%) |
Mitral ViV | 0 | 0 | 1 (12.5%) | 0 | 0 | 0 | 0 |
Peripheral intervention | 0 | 1 (4%) | 0 | 0 | 0 | 0 | 0 |
DAPT N = 13 | DOAC Only N = 25 | Warfarin Only N = 8 | SAPT + DOAC N = 44 | SAPT + Warfarin N = 17 | Triple (DAPT + DOAC) N = 7 | Triple (DAPT + Warfarin) N = 7 | |
---|---|---|---|---|---|---|---|
Early MI | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
Conduction disturbances requiring PPM | 5 (38.46%) | 3 (12%) | 1 (12.5%) | 4 (9.09%) | 4 (23.53%) | 0 | 1 (14.29%) |
Requiring ICD | 0 | 0 | 0 | 0 | 1 (5.88%) | 0 | 0 |
Early Stroke | 0 | 0 | 1 (12.5%) | 1 (2.3%) | 0 | 0 | 0 |
Retroperitoneal bleeding | 1 (7.69%) | 0 | 0 | 0 | 0 | 0 | 0 |
Gastrointestinal bleeding | 0 | 0 | 0 | 1 (2.27%) | 0 | 0 | 0 |
Genitourinary bleeding | 1 (7.69%) | 0 | 0 | 1 (2.27%) | 0 | 0 | 0 |
Other bleeding | 0 | 0 | 0 | 0 | 2 (11.76%) | 0 | 0 |
DAPT N = 13 | DOAC only N = 25 | Warfarin only N = 8 | SAPT + DOAC N = 44 | SAPT + Warfarin N = 17 | Triple (DAPT + DOAC) N = 7 | Triple (DAPT + Warfarin) N = 7 | |
---|---|---|---|---|---|---|---|
Stroke or TIA | 2 (15.38%) | 3 (12%) | 1 (12.5%) | 3 (6.8%) | 2 (11.76%) | 1 (14.29%) | 2 (28.57%) |
Ischemic Stroke | 2 | 3 | 0 | 2 | 1 | 1 | 2 |
Undetermined Stroke | 0 | 0 | 0 | 0 | 1 | 0 | 0 |
TIA | 0 | 0 | 1 | 1 | 0 | 0 | 0 |
Major Bleeding | 0 | 1 (4%) | 2 (25%) | 5 (11.36%) | 0 | 0 | 0 |
GI Bleeding | 0 | 1 | 2 | 3 | 0 | 0 | 0 |
Intraocular Bleeding | 0 | 0 | 0 | 1 | 0 | 0 | 0 |
Genitourinary Bleeding | 0 | 0 | 0 | 1 | 0 | 0 | 0 |
Mortality | 5 (38.46%) | 2 (8%) | 2 (25%) | 3 (6.82%) | 7 (41.18%) | 1 (14.29%) | 4 (57.14%) |
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Awan, R.; Albabtain, M.A.; AlRasheedi, A.; AlHarthi, M.; Alanazi, Z.; Arafat, A.A. Personalized Antithrombotic Strategies in Patients with Atrial Fibrillation Following Transcatheter Aortic Valve Replacement. J. Pers. Med. 2025, 15, 149. https://doi.org/10.3390/jpm15040149
Awan R, Albabtain MA, AlRasheedi A, AlHarthi M, Alanazi Z, Arafat AA. Personalized Antithrombotic Strategies in Patients with Atrial Fibrillation Following Transcatheter Aortic Valve Replacement. Journal of Personalized Medicine. 2025; 15(4):149. https://doi.org/10.3390/jpm15040149
Chicago/Turabian StyleAwan, Razan, Monirah A. Albabtain, Aisha AlRasheedi, Maha AlHarthi, Zaid Alanazi, and Amr A. Arafat. 2025. "Personalized Antithrombotic Strategies in Patients with Atrial Fibrillation Following Transcatheter Aortic Valve Replacement" Journal of Personalized Medicine 15, no. 4: 149. https://doi.org/10.3390/jpm15040149
APA StyleAwan, R., Albabtain, M. A., AlRasheedi, A., AlHarthi, M., Alanazi, Z., & Arafat, A. A. (2025). Personalized Antithrombotic Strategies in Patients with Atrial Fibrillation Following Transcatheter Aortic Valve Replacement. Journal of Personalized Medicine, 15(4), 149. https://doi.org/10.3390/jpm15040149