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Vol. 71. Issue 4.
Pages 309 (April 2018)
Letter to the Editor
DOI: 10.1016/j.rec.2017.10.027
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Antithrombotic Therapy After Percutaneous Aortic Valve Implantation: Large Gaps for a Matter of Extreme Importance. Response
Tratamiento antitrombótico tras implante percutáneo de válvula aórtica: grandes lagunas para una cuestión de extrema importancia. Respuesta
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Giuseppe De Luca
Corresponding author
, Monica Verdoia
Division of Cardiology, Azienda Ospedaliera-Universitaria “Maggiore della Carità”, Eastern Piedmont University, Novara, Italy
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Rev Esp Cardiol. 2018;71:30810.1016/j.rec.2017.08.023
Íñigo Lozano, Juan Rondán, José M. Vegas, Eduardo Segovia
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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.

References
[1]
M. Verdoia, L. Barbieri, M. Nardin, H. Suryapranata, G. De Luca.
Dual Versus Single Antiplatelet Regimen With or Without Anticoagulation in Transcatheter Aortic Valve Replacement: Indirect Comparison and Meta-analysis.
Rev Esp Cardiol., 71 (2018), pp. 257-267
[2]
G. De Luca, A. Schaffer, J. Wirianta, H. Suryapranata.
Comprehensive meta-analysis of radial vs femoral approach in primary angiooplasty for STEMI.
Int J Cardiol., 168 (2013), pp. 2070-2081
[3]
H. Baumgartner, V. Falk, J.J. Bax, 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).
http://dx.doi.org/10.1093/eurheartj/ehx391
Copyright © 2017. Sociedad Española de Cardiología
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