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Revista Española de Cardiología (English Edition) Revista Española de Cardiología (English Edition)
Rev Esp Cardiol. 2018;71:309 - Vol. 71 Num.04 DOI: 10.1016/j.rec.2017.10.027

Antithrombotic Therapy After Percutaneous Aortic Valve Implantation: Large Gaps for a Matter of Extreme Importance. Response

Giuseppe De Luca a,, Monica Verdoia a

a Division of Cardiology, Azienda Ospedaliera-Universitaria “Maggiore della Carità”, Eastern Piedmont University, Novara, Italy

Refers to

Free articleAntithrombotic Therapy After Percutaneous Aortic Valve Implantation: Large Gaps for a Matter of Extreme Importance
Íñigo Lozano, Juan Rondán, José M. Vegas, Eduardo Segovia
Rev Esp Cardiol. 2018;71:308
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To the Editor,

We thank Lozano et al. for their interest on our study.1 We agree with these authors that strategies aiming to reduce major bleeding complications may positively affect clinical outcome.2

However, our findings suggest that dual antiplatelet therapy (DAPT) provides clinical benefits (in mortality and in stroke) compared with monoantiplatelet therapy, with no difference in major bleedings (15.5% in DAPT vs 17.2% in monoantiplatelet therapy, P = .11).

Our study should certainly be interpreted in light of the limitations highlighted in our article, such as the unbalanced distribution among the groups due to nonrandomized treatment allocation.

However, due to the paucity of available data from randomized trials (only 421 patients, as stressed by Lozano et al.), our study, including more than 6000 patients, certainly helps to shed light on the argument.

Our data are in step with the current guidelines of major scientific societies that recommend DAPT for 3 to 6 months after transcatheter aortic valve implantation (TAVI).3

Future large randomized trials are certainly needed to provide further data and potentially define the optimal antithrombotic strategy after TAVI. However, Lozano et al. will certainly agree that, while these data are awaited, based on our study, DAPT can certainly be recommended after TAVI.

Corresponding author:


1. Verdoia M, Barbieri L, Nardin M, Suryapranata H, De Luca G. Dual Versus Single Antiplatelet Regimen With or Without Anticoagulation in Transcatheter Aortic Valve Replacement: Indirect Comparison and Meta-analysis. Rev Esp Cardiol. 2018;71:257-67.
2. De Luca G, Schaffer A, Wirianta J, Suryapranata H. Comprehensive meta-analysis of radial vs femoral approach in primary angiooplasty for STEMI. Int J Cardiol. 2013;168:2070-81.
3. Baumgartner H, Falk V, Bax JJ, et al. 2017 ESC/EACTS Guidelines for the management of valvular heart disease: The Task Force for the Management of Valvular Heart Disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2017.

1885-5857/© 2018 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved