Breaking News
November 19, 2018 - Neural networks could replace marker genes in RNA sequencing
November 19, 2018 - Obese adolescents feel less food enjoyment than those with normal weight, study reveals
November 18, 2018 - Goodbye ‘Gluten-Free’? Celiac Disease Vaccine May Make It Possible
November 18, 2018 - Skin ages when the main cells in the dermis lose their identity and function
November 18, 2018 - Rainforest vine compound makes pancreatic cancer cells susceptible to nutrient starvation
November 18, 2018 - A new mechanism in the control of inflammation
November 18, 2018 - Age-related decline in abstract reasoning ability predicts depressive symptoms over time
November 18, 2018 - Scientists succeed in increasing stability, biocompatibility of light-transducing nanoparticles
November 18, 2018 - Sugar, a ‘sweet’ tool to understand brain injuries
November 18, 2018 - Pharmacist-Led Effort Cuts Inappropriate Rx in Older Adults
November 18, 2018 - Novel discovery could lead to new cancer, autoimmune disease therapy
November 18, 2018 - AHA and ADA launch new initiative to help people with type 2 diabetes reduce heart disease risk
November 18, 2018 - Balanced production of pro and anti-inflammatory cytokines at two years of age protects against malaria
November 18, 2018 - New pharmacological agent shows promise for prevention of heart rhythm disorders
November 18, 2018 - All That Social Media May Boost Loneliness, Not Banish It
November 18, 2018 - Scientists shine new light on link between obesity and cancer
November 18, 2018 - Risk factors for cardiovascular disease closely track with changes in diet patterns
November 18, 2018 - Biogen Scoops Sixth Prix Galien Award with UK Win for Life-Changing Rare Disease Medicine
November 18, 2018 - Detectable HIV-1 in treated human liver cells found to be inert
November 18, 2018 - Using light to control crucial step in embryonic development
November 18, 2018 - Unusual case of father-to-son HIV transmission reported
November 18, 2018 - FDA Approves Aemcolo (rifamycin) to Treat Travelers’ Diarrhea
November 18, 2018 - Poverty blamed on widening north-south gap in young adult deaths in England
November 18, 2018 - Progress in meningitis lags far behind other vaccine-preventable diseases, analysis shows
November 18, 2018 - Consensus Statement Issued on Management of Foot, Ankle Gout
November 18, 2018 - Fine particle air pollution is a public health emergency hiding in plain sight
November 18, 2018 - In-hospital mortality higher among patients with drug-resistant infections
November 17, 2018 - Research shines new, explanatory light on link between obesity and cancer
November 17, 2018 - FIND explores new diagnostic assays for confirmatory HCV diagnosis in community settings
November 17, 2018 - Tracking Preemies’ Head Size May Yield IQ Clues
November 17, 2018 - Scientists call for unified standards in 3-D genome and epigenetic data
November 17, 2018 - Lab Innovations 2018 has beaten all records by attracting 3,113 attendees
November 17, 2018 - New strategy to hinder emergence of antimicrobial-resistant pathogens
November 17, 2018 - Sexuality education before age 18 may reduce risk of sexual assault in college
November 17, 2018 - Reducing cellular proliferation could help deplete HIV reservoir and lead to a functional cure
November 17, 2018 - New model of FSHD could be useful to study effectiveness of experimental therapeutics
November 17, 2018 - FDA approves antibacterial drug to treat travelers’ diarrhea
November 17, 2018 - Lab Innovations 2018 confirmed as a major hit with visitors, exhibitors and speakers
November 17, 2018 - Largest parasitic worm genetic study hatches novel treatment possibilities
November 17, 2018 - UCLA biologists uncover how head injuries can lead to serious brain disorders
November 17, 2018 - Static and dynamic physical activities offer varying protection against heart disease
November 17, 2018 - Obesity significantly increases risk of Type 2 diabetes and coronary artery disease
November 17, 2018 - New method to analyze cell membrane complexes could revolutionize the way we study diseases
November 17, 2018 - Researchers show how proteins interact in hypoxic conditions to facilitate mitochondrial fission
November 17, 2018 - People with rare cancers can benefit from genomic profiling, shows research
November 17, 2018 - NIH awards over $1.8 million to husband-and-wife doctors to test new breast cancer approach
November 17, 2018 - Four-in-one antibody used to fight flu shows promise in mice
November 17, 2018 - New approach allows pathogens to be starved by blocking important enzymes
November 17, 2018 - Higher body mass index could cause depression even without health problems
November 17, 2018 - Protein which plays role in sensing cell damage serves as new target to treat pulmonary hypertension
November 17, 2018 - FDA Approves Adcetris (brentuximab vedotin) in Combination with Chemotherapy for Adults with Previously Untreated Systemic Anaplastic Large Cell Lymphoma or Other CD30-Expressing Peripheral T-Cell Lymphomas
November 17, 2018 - ID specialist input improves outcomes for outpatient parenteral antimicrobial therapy
November 17, 2018 - UT Southwestern scientists selected to receive 2019 Edith and Peter O’Donnell Awards
November 17, 2018 - New clinical algorithm to help individuals manage type 2 diabetes when fasting during Ramadan
November 17, 2018 - Researchers identify LZTR1 as evolutionarily conserved component of RAS pathway
November 17, 2018 - Heart Disease Leading Cause of Death in Low-Income Counties
November 17, 2018 - Estrogen Levels Test: MedlinePlus Lab Test Information
November 17, 2018 - Research reveals link between immunity, diabetes
November 17, 2018 - Research shows how to achieve improved smoking cessation outcomes within California’s Medicaid population
November 17, 2018 - New study finds less understanding and implementation of patient engagement
November 17, 2018 - New shoe insole technology could help diabetic ulcers heal better while walking
November 17, 2018 - New method to extend cell division and immortalization of avian-derived cells
November 17, 2018 - Australian Academy of Science urges parents to vaccinate children against meningococcal disease
November 17, 2018 - Hot water treatment may help improve inflammation and metabolism in sedentary people
November 17, 2018 - Researchers produce 3D chemical maps of small biological samples
November 17, 2018 - Must Blood Pressure Rise Wth Age? Remote Tribes Hold Clues
November 17, 2018 - Noonan Syndrome
November 17, 2018 - Interventions to delay and prevent type 2 diabetes are underused, researchers say
November 17, 2018 - Hackathon prize winner seeks to remotely monitor patient skin conditions
November 17, 2018 - Research team identifies Ashkenazi Jewish founder mutation for Leigh syndrome
November 17, 2018 - Gene editing could be used to halt kidney disease in patients with Joubert syndrome
November 17, 2018 - Study uncovers link between gut disruption and aging
November 17, 2018 - Teens more likely to pick up smoking after exposure from friends and family
November 17, 2018 - Nicoya designate the Institute for Stem Cell Biology and Regenerative Medicine as the OpenSPR Centre of Excellence
November 17, 2018 - new horizon in dental, oral and craniofacial research
November 17, 2018 - How does poor air quality affect your health?
November 17, 2018 - New device can regulate children’s blood glucose more like natural pancreas
November 17, 2018 - Game-Changers in Western Blotting and Protein Analysis
November 17, 2018 - FDA announces new actions to limit sale of e-cigarettes to youth
November 17, 2018 - Warmer winter temperatures related to higher crime rates
Mono-antiplatelet therapy after aortic heart valve replacements may work as well as two drugs

Mono-antiplatelet therapy after aortic heart valve replacements may work as well as two drugs

image_pdfDownload PDFimage_print

Current treatment guidelines say patients who undergo minimally invasive aortic heart valve replacements should receive two antiplatelet drugs to reduce the risk of dangerous blood clots.

A new Loyola Medicine study has found that giving patients a single antiplatelet drug may work as well as giving two drugs, with significantly lower risks of life-threatening bleeding and other complications.

The meta-analysis by senior author Verghese Mathew, MD, and colleagues is published in the American Journal of Cardiology. Dr. Mathew, an internationally known interventional cardiologist, is chair of Loyola’s division of cardiology.

The aortic valve regulates blood flow from the left ventricle (the heart’s main pumping chamber) to the aorta (the body’s largest artery). Narrowing of the aortic valve, known as aortic stenosis, can cause fatigue, chest pain and other symptoms and lead to heart failure and death. Replacing a diseased aortic valve traditionally required open heart surgery.

Since 2011, a minimally invasive technique to implant an artificial valve with a catheter has been commercially available in the United States. The technique is called transcatheter aortic valve replacement (TAVR). The catheter typically is inserted into an artery in the groin and guided up to the heart, where the valve is deployed.

To reduce the risk of clots that may form on the new valve, cardiologists prescribe antiplatelet drugs. Such medications stop blood cells called platelets from sticking together and forming clots, which can cause heart attacks and strokes. Among the most commonly used antiplatelets are aspirin and clopidogrel (Plavix). Current guidelines recommend TAVR patients receive two antiplatelets, known as dual-antiplatelet therapy. However, treatments vary. Some cardiologists prescribe just one antiplatelet, known as mono-antiplatelet therapy. Mono-antiplatelet therapy usually is prescribed in certain patients if there’s an increased concern of bleeding from using two drugs.

In the new study, Dr. Mathew and colleagues pooled results of eight previous studies that compared mono-antiplatelet therapy to dual-antiplatelet therapy. The studies included 2,439 patients. In four studies, patients received the Sapien aortic valve. In two studies, they received the CoreValve device. In two studies, both valves were used.

At 30 days, patients who received two antiplatelet agents were 2.06 times more likely to die, 2.04 times more likely to have major or life-threatening bleeding and 2.15 times more likely to have major vascular complications. But there were no statistically significant differences between the single-drug and dual-drug groups in stroke, heart attack or transient ischemic attack (mini stroke).

“These data suggest a safety concern with dual-antiplatelet therapy and underscore the need for a large randomized trial to definitely address this question,” Dr. Mathew and colleagues wrote.

The study did not include TAVR patients who required anticoagulants such as warfarin (Coumadin) or newer direct oral anticoagulants (DOACS) for other indications that increase the risk of blood clots, such as atrial fibrillation. In such cases, adding antiplatelet drugs increases the risk of bleeding.

Numerous ongoing prospective studies are designed to determine which regimen achieves the best balance between clotting risk and bleeding risk after TAVR.

Source:

https://www.loyolamedicine.org/

Tagged with:

About author

Related Articles