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Usefulness of Clopidogrel Loading in Patients Who Underwent Transcatheter Aortic Valve Implantation (from the BRAVO-3

Vincent Johan Nijenhuis1, Jurrien Maria Ten Berg1, Christian Hengstenberg2

  • 1Department of Cardiology, St. Antonius hospital, Nieuwegein, the Netherlands.

The American Journal of Cardiology
|March 4, 2019
PubMed

Insights

Initiating clopidogrel with a loading dose (LD) before transcatheter aortic valve implantation (TAVI) did not improve outcomes but increased vascular complications. No significant difference in major adverse cardiovascular events or bleeding was observed between LD and no LD groups.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Pharmacology

Background:

  • P2Y12-inhibitor initiation with clopidogrel loading dose (LD) rapidly inhibits platelet activation and reduces ischemic events post-coronary stenting.
  • The efficacy of clopidogrel LD in transcatheter aortic valve implantation (TAVI) patients remains unclear.

Purpose of the Study:

  • To evaluate the impact of preprocedural clopidogrel LD versus no LD on 48-hour and 30-day clinical outcomes after TAVI.
  • To assess the association between clopidogrel LD and major adverse cardiovascular events, major bleeding, and major vascular complications in TAVI patients.

Main Methods:

  • Analysis of 802 patients from the BRAVO-3 trial who underwent transfemoral TAVI.
  • Stratification of patients into clopidogrel LD (n=294) and no LD (n=508) groups based on physician discretion.
  • Comparison of clinical outcomes, including major adverse cardiovascular events, major bleeding, and major vascular complications, between the two groups.

Main Results:

  • Clopidogrel LD was associated with a higher rate of major vascular complications (11.9% vs 7.1%, p=0.02).
  • No significant differences were observed in major adverse cardiovascular events (4.1% vs 4.1%, p=0.97) or major bleeding (8.5% vs 7.7%, p=0.68) between LD and no LD groups.
  • Multivariable analysis confirmed clopidogrel LD did not significantly affect clinical events, including major vascular complications (OR 0.91, 95% CI 0.60-1.39, p=0.67).

Conclusions:

  • In TAVI patients, preprocedural clopidogrel LD is linked to increased vascular complications without improving other clinical outcomes.
  • Routine use of clopidogrel LD in TAVI patients is not supported by these findings.
  • Further research may be needed to optimize P2Y12 inhibitor strategies in TAVI.

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