Antithrombotic selection in patients undergoing transcatheter aortic valve replacement.
Purpose Clinical controversy regarding the most appropriate antithrombotic regimen after transcatheter aortic valve replacement remains. Current evidence, guidelines, and recommendations are discussed. Summary Antithrombotic selection following transcatheter aortic valve replacement depends on a var...
| Publicado en: | American Journal of Health-System Pharmacy Vol. 78; no. 1; pp. 22 - 36 |
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| Autores principales: | , , , |
| Formato: | algorithm critical path practice guidelines review tables/charts Journal Article |
| Publicado: |
Oxford University Press / USA
Jan2021
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=147645168&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 147645168 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 10792082 1X3 jtl: American Journal of Health-System Pharmacy issn: 10792082 maglogo: N pubinfo: dt: Jan2021 vid: 78 iid: 1 pid: 622 pub: Oxford University Press / USA artinfo: ui: 147645168 147645168 147645168 10.1093/ajhp/zxaa329 147645168 ppf: 22 ppct: 14 formats: fmt: – @attributes: type: T – @attributes: type: P tig: atl: Antithrombotic selection in patients undergoing transcatheter aortic valve replacement. aug: au: Lai, Jennifer K Willenborg, Katie L Berei, Theodore Rose, Anne E affil: Department of Pharmacy, University of Wisconsin Hospital and Clinics , Madison, WI sug: subj: Fibrinolytic Agents Therapeutic Use Transcatheter Aortic Valve Implantation Thromboembolism Prevention and Control Practice Guidelines Medical Practice, Evidence-Based Dual Antiplatelet Therapy Warfarin Therapeutic Use Platelet Aggregation Inhibitors Therapeutic Use Ischemia Prevention and Control Treatment Outcomes Rivaroxaban Adverse Effects Atrial Fibrillation Complications Postoperative Hemorrhage Prevention and Control Comorbidity ab: Purpose Clinical controversy regarding the most appropriate antithrombotic regimen after transcatheter aortic valve replacement remains. Current evidence, guidelines, and recommendations are discussed. Summary Antithrombotic selection following transcatheter aortic valve replacement depends on a variety of patient-specific factors. For patients without a preexisting indication for anticoagulation, initial trials employed dual antiplatelet therapy as the postprocedural therapy of choice. Newer studies in this patient population, however, suggest single antiplatelet therapy reduces bleeding events without sacrificing ischemic protection. In patients with a preexisting indication for anticoagulation, warfarin plus single antiplatelet therapy, as opposed to triple antithrombotic therapy, offered similar ischemic protection while reducing clinically significant bleeding. Warfarin monotherapy was associated with a further reduction in bleeding events. One trial demonstrated the safety and efficacy of using apixaban in patients with concomitant atrial fibrillation; however, routine use of rivaroxaban increased adverse cardiac and bleeding events, leaving the utility of direct-acting oral anticoagulants in question. Conclusion Available evidence and current guidelines point to a lack of consensus regarding antithrombotic selection after transcatheter aortic valve replacement. Patient-specific factors and comorbidities must be considered when tailoring therapy, with an emphasis on balancing thrombotic and bleeding risks. pubtype: Academic Journal doctype: algorithm critical path practice guidelines review tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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