Post-Discharge Antithrombotic Therapy Following Transcatheter Aortic Valve Implantation in Australian Patients.
Aftercare
Aged, 80 and over
Anticoagulants
/ adverse effects
Aortic Valve
/ surgery
Aortic Valve Stenosis
/ surgery
Australia
/ epidemiology
Clopidogrel
Female
Fibrinolytic Agents
/ therapeutic use
Humans
Male
Patient Discharge
Platelet Aggregation Inhibitors
/ therapeutic use
Retrospective Studies
Risk Factors
Transcatheter Aortic Valve Replacement
/ adverse effects
Treatment Outcome
Warfarin
Antithrombotic
Direct oral anticoagulants
Oral anticoagulants
P2Y12 inhibitor
Transcatheter aortic valve implantation
Journal
Heart, lung & circulation
ISSN: 1444-2892
Titre abrégé: Heart Lung Circ
Pays: Australia
ID NLM: 100963739
Informations de publication
Date de publication:
Aug 2022
Aug 2022
Historique:
received:
13
01
2022
revised:
29
03
2022
accepted:
26
04
2022
pubmed:
1
6
2022
medline:
27
7
2022
entrez:
31
5
2022
Statut:
ppublish
Résumé
Guidelines recommend antithrombotic therapy for patients following transcatheter aortic valve implantation (TAVI) to reduce the risk of ischaemic events and bioprosthetic valve thrombosis. To describe antithrombotic dispensing within 30 days of discharge for Australian patients receiving TAVI. We performed a state-wide retrospective cohort study using linked hospital and medicines dispensing data from January 2013 to December 2018 for all patients receiving TAVI in New South Wales, Australia. We identified patients dispensed oral anticoagulants (vitamin K antagonists [warfarin], direct oral anticoagulants [DOACs]) or clopidogrel within 30 days of discharge. We examined demographic and clinical predictors of antithrombotic dispensing. Our cohort comprised 1,217 patients who underwent TAVI; median age was 84 years and 707 (58.1%) were male. Of these, 808 patients (66.4%) had an antithrombotic dispensed within 30 days of hospital discharge. One-third (33.7%) of these patients were dispensed an anticoagulant (16.1% warfarin; 17.6% DOACs) and two-thirds (66.3%) were dispensed clopidogrel. Patients undergoing TAVI were more likely to be dispensed an antithrombotic medicine within 30-days of hospital discharge if they had been dispensed antithrombotic medicines (RR 1.07; 95% CI 1.03-1.11) or angiotensin-converting-enzyme inhibitors/angiotensin II receptor blockers (RR 1.04; 95% CI 1.00-1.07) in the 6 months prior to admission. Patients with a history of haemorrhage were less likely to be dispensed an antithrombotic medicine within 30 days of hospital discharge (RR 0.93; 95% CI 0.89-0.98). We observed gaps in best evidence pharmacotherapy for patients post-TAVI, with almost one third of patients not receiving antithrombotic medicines post-discharge. Further research is needed to quantify the impact of emerging clinical guidelines recommending single antiplatelet therapy, on adherence to best-practice care.
Sections du résumé
BACKGROUND
BACKGROUND
Guidelines recommend antithrombotic therapy for patients following transcatheter aortic valve implantation (TAVI) to reduce the risk of ischaemic events and bioprosthetic valve thrombosis.
OBJECTIVE
OBJECTIVE
To describe antithrombotic dispensing within 30 days of discharge for Australian patients receiving TAVI.
METHODS
METHODS
We performed a state-wide retrospective cohort study using linked hospital and medicines dispensing data from January 2013 to December 2018 for all patients receiving TAVI in New South Wales, Australia. We identified patients dispensed oral anticoagulants (vitamin K antagonists [warfarin], direct oral anticoagulants [DOACs]) or clopidogrel within 30 days of discharge. We examined demographic and clinical predictors of antithrombotic dispensing.
RESULTS
RESULTS
Our cohort comprised 1,217 patients who underwent TAVI; median age was 84 years and 707 (58.1%) were male. Of these, 808 patients (66.4%) had an antithrombotic dispensed within 30 days of hospital discharge. One-third (33.7%) of these patients were dispensed an anticoagulant (16.1% warfarin; 17.6% DOACs) and two-thirds (66.3%) were dispensed clopidogrel. Patients undergoing TAVI were more likely to be dispensed an antithrombotic medicine within 30-days of hospital discharge if they had been dispensed antithrombotic medicines (RR 1.07; 95% CI 1.03-1.11) or angiotensin-converting-enzyme inhibitors/angiotensin II receptor blockers (RR 1.04; 95% CI 1.00-1.07) in the 6 months prior to admission. Patients with a history of haemorrhage were less likely to be dispensed an antithrombotic medicine within 30 days of hospital discharge (RR 0.93; 95% CI 0.89-0.98).
CONCLUSIONS
CONCLUSIONS
We observed gaps in best evidence pharmacotherapy for patients post-TAVI, with almost one third of patients not receiving antithrombotic medicines post-discharge. Further research is needed to quantify the impact of emerging clinical guidelines recommending single antiplatelet therapy, on adherence to best-practice care.
Identifiants
pubmed: 35637093
pii: S1443-9506(22)00193-7
doi: 10.1016/j.hlc.2022.04.048
pii:
doi:
Substances chimiques
Anticoagulants
0
Fibrinolytic Agents
0
Platelet Aggregation Inhibitors
0
Warfarin
5Q7ZVV76EI
Clopidogrel
A74586SNO7
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1144-1152Subventions
Organisme : FDA HHS
ID : U01 FD006936
Pays : United States
Informations de copyright
Copyright © 2022 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.