Abstract
Objectives: This paper reviews literary evidence on antithrombotic therapies currently employed in TAVR to assess validity and efficacy; duration and modality are also considered. In the absence of firm guidelines and reliable trial results, we analyze current knowledge of interaction between PPI and antithrombotic drugs.
Background: TAVR has been associated with Double Antiplatelet Therapy since 2002. This was an empirical approach for a new stentmounted tissue valve to prevent early and late MACCE that affect survival and quality of life.
Data Sources: Systematic searches of major bibliographic databases, contact with experts in the field, and review of primary articles, review papers, and guidelines has been performed.
Methods: We analyze TAVR features and pitfalls in existing trials to understand which therapy would fit patients better and we confront these with established clinical practice guidelines of the population treated for cardiovascular disease.
Conclusions: TAVR is a new technology that compresses a tissue valve onto an expandable stent. Technical and procedural issues have been solved, but strokes and major bleeding still affect patients’ life despite double antiplatelet therapy given to reduce MACCE. To balance pros and cons, antithrombotic therapy with Warfarin or new anticoagulants can be used in patients with previous AF or NOAF to prevent stroke; while single antiplatelet with PPI is a better alternative in patients with liver disease, gastric ulcer or drug abuse to avoid bleeding events. While waiting for randomized trials, a tailored therapy based upon physician’s experience and close patient follow-up is the safest, most effective treatment.
Keywords: Aortic stenosis, transcatheter aortic valve replacement, TAVR, TAVI, antiplatelet and antithrombotic therapy, proton pump inhibitor, PPI.
Current Pharmaceutical Design
Title:Clopidogrel, Aspirin and Proton Pump Inhibition after Percutaneous Valve Implants: An Update
Volume: 19 Issue: 22
Author(s): Melissa Fusari
Affiliation:
Keywords: Aortic stenosis, transcatheter aortic valve replacement, TAVR, TAVI, antiplatelet and antithrombotic therapy, proton pump inhibitor, PPI.
Abstract: Objectives: This paper reviews literary evidence on antithrombotic therapies currently employed in TAVR to assess validity and efficacy; duration and modality are also considered. In the absence of firm guidelines and reliable trial results, we analyze current knowledge of interaction between PPI and antithrombotic drugs.
Background: TAVR has been associated with Double Antiplatelet Therapy since 2002. This was an empirical approach for a new stentmounted tissue valve to prevent early and late MACCE that affect survival and quality of life.
Data Sources: Systematic searches of major bibliographic databases, contact with experts in the field, and review of primary articles, review papers, and guidelines has been performed.
Methods: We analyze TAVR features and pitfalls in existing trials to understand which therapy would fit patients better and we confront these with established clinical practice guidelines of the population treated for cardiovascular disease.
Conclusions: TAVR is a new technology that compresses a tissue valve onto an expandable stent. Technical and procedural issues have been solved, but strokes and major bleeding still affect patients’ life despite double antiplatelet therapy given to reduce MACCE. To balance pros and cons, antithrombotic therapy with Warfarin or new anticoagulants can be used in patients with previous AF or NOAF to prevent stroke; while single antiplatelet with PPI is a better alternative in patients with liver disease, gastric ulcer or drug abuse to avoid bleeding events. While waiting for randomized trials, a tailored therapy based upon physician’s experience and close patient follow-up is the safest, most effective treatment.
Export Options
About this article
Cite this article as:
Fusari Melissa, Clopidogrel, Aspirin and Proton Pump Inhibition after Percutaneous Valve Implants: An Update, Current Pharmaceutical Design 2013; 19 (22) . https://dx.doi.org/10.2174/1381612811319220002
DOI https://dx.doi.org/10.2174/1381612811319220002 |
Print ISSN 1381-6128 |
Publisher Name Bentham Science Publisher |
Online ISSN 1873-4286 |
Call for Papers in Thematic Issues
"Tuberculosis Prevention, Diagnosis and Drug Discovery"
The Nobel Prize-winning discoveries of Mycobacterium tuberculosis and streptomycin have enabled an appropriate diagnosis and an effective treatment of tuberculosis (TB). Since then, many newer diagnosis methods and drugs have been saving millions of lives. Despite advances in the past, TB is still a leading cause of infectious disease mortality ...read more
Current Pharmaceutical challenges in the treatment and diagnosis of neurological dysfunctions
Neurological dysfunctions (MND, ALS, MS, PD, AD, HD, ALS, Autism, OCD etc..) present significant challenges in both diagnosis and treatment, often necessitating innovative approaches and therapeutic interventions. This thematic issue aims to explore the current pharmaceutical landscape surrounding neurological disorders, shedding light on the challenges faced by researchers, clinicians, and ...read more
Emerging and re-emerging diseases
Faced with a possible endemic situation of COVID-19, the world has experienced two important phenomena, the emergence of new infectious diseases and/or the resurgence of previously eradicated infectious diseases. Furthermore, the geographic distribution of such diseases has also undergone changes. This context, in turn, may have a strong relationship with ...read more
Melanoma and Non-Melanoma Skin Cancer Treatment: Standard of Care and Recent Advances
In this thematic issue, we aim to provide a standard of care of the diagnosis and treatment of melanoma and non-melanoma skin cancer. The editor will invite authors from different countries who will write review articles of melanoma and non-melanoma skin cancers. The Diagnosis, Staging, Surgical Treatment, Non-Surgical Treatment all ...read more
- Author Guidelines
- Graphical Abstracts
- Fabricating and Stating False Information
- Research Misconduct
- Post Publication Discussions and Corrections
- Publishing Ethics and Rectitude
- Increase Visibility of Your Article
- Archiving Policies
- Peer Review Workflow
- Order Your Article Before Print
- Promote Your Article
- Manuscript Transfer Facility
- Editorial Policies
- Allegations from Whistleblowers
- Announcements
Related Articles
-
On the Involvement of H2S in Nitroso Signaling and Other Mechanisms of H2S Action
Current Pharmaceutical Biotechnology Dissecting Insulin Signaling Pathways: Individualised Therapeutic Targets for Diagnosis and Treatment of Insulin Resistant States
Endocrine, Metabolic & Immune Disorders - Drug Targets Renin Angiotensin System (RAS) and Immune System Profile in Specific Subgroups with COVID-19
Current Medicinal Chemistry Effects of Creatine in Skeletal Muscle Cells and in Myoblasts Differentiating Under Normal or Oxidatively Stressing Conditions
Mini-Reviews in Medicinal Chemistry Lipid Management and Peripheral Arterial Disease
Current Drug Targets Design and Development of Nanovehicle-Based Delivery Systems for Preventive or Therapeutic Supplementation with Flavonoids
Current Medicinal Chemistry Microalbuminuria: A Neglected Cardiovascular Risk Factor in Non-diabetic Individuals?
Current Pharmaceutical Design Incidence and Prevalence of Hypothyroidism in Patients Affected by Chronic Heart Failure: Role of Amiodarone
Endocrine, Metabolic & Immune Disorders - Drug Targets Pharmacologic Therapy in Growth Hormone Disorders and the Heart
Current Medicinal Chemistry Combining Diffusion-Weighted Imaging Patterns with ABCD2 Score Predicts Stroke Risk after Transient Ischemic Attack
Current Neurovascular Research Platelet Oxidative Stress and its Relationship with Cardiovascular Diseases in Type 2 Diabetes Mellitus Patients
Current Medicinal Chemistry Multi-Target Profile of Oleocanthal, An Extra-Virgin Olive Oil Component
Current Bioactive Compounds Piperine: Medicinal, Analytical and Therapeutics perspective
Current Bioactive Compounds Potential Interactions between miRNAs and Hypoxia: A New Layer in Cancer Hypoxia
Anti-Cancer Agents in Medicinal Chemistry Role of Coronary Microvascular Endothelial Dysfunction in the Development of Heart Failure
Current Cardiology Reviews Regular Physical Activity and Vascular Aging
Current Pharmaceutical Design Atherogenesis in White Coat Hypertension
Current Hypertension Reviews A Review of Dietary Influences on Cardiovascular Health: Part 1: the role of Dietary Nutrients
Cardiovascular & Hematological Disorders-Drug Targets Coenzyme Q10 in Cardiovascular and Metabolic Diseases: Current State of the Problem
Current Cardiology Reviews Obesity in the Cardiovascular Continuum
Current Clinical Pharmacology