Assessment of Platelet REACtivity After Transcatheter Aortic Valve Replacement : The REAC-TAVI Trial
Jimenez Diaz, Victor Alfonso (Hospital Álvaro Cunqueiro (Vigo))
Tello-Montoliu, Antonio (Centro de Investigación en Red de Enfermedades Cardiovasculares)
Moreno, Raul (Hospital Universitario La Paz (Madrid))
Cruz Gonzalez, Ignacio (Hospital Universitario de Salamanca)
Baz Alonso, Jose Antonio (Hospital Álvaro Cunqueiro (Vigo))
Romaguera, Rafael (Hospital Universitari de Bellvitge)
Molina Navarro, Eduardo (Hospital Universitario Virgen de las Nieves (Granada))
Juan Salvadores, Pablo (Fundación Biomédica Galicia Sur)
Paredes Galan, Emilio (Hospital Álvaro Cunqueiro (Vigo))
De Miguel-Castro, Antonio (Hospital Álvaro Cunqueiro (Vigo))
Bastos Fernandez, Guillermo (Hospital Álvaro Cunqueiro (Vigo))
Ortiz Saez, Alberto (Hospital Álvaro Cunqueiro (Vigo))
Fernandez Barbeira, Saleta (Hospital Álvaro Cunqueiro (Vigo))
Raposeiras Roubin, Sergio (Hospital Álvaro Cunqueiro (Vigo))
Ocampo Miguez, Juan (Hospital Álvaro Cunqueiro (Vigo))
Serra Peñaranda, Antonio (Institut d'Investigació Biomèdica Sant Pau)
Valdes Chavarri, Mariano (Centro de Investigación en Red de Enfermedades Cardiovasculares)
Cequier, Ángel (Hospital Universitari de Bellvitge)
Calvo Iglesias, Francisco (Hospital Álvaro Cunqueiro (Vigo))
Iñiguez Romo, Andrés (Centro de Investigación en Red de Enfermedades Cardiovasculares)
Universitat Autònoma de Barcelona

Data:	2019
Resum:	The REAC-TAVI (Assessment of platelet REACtivity after Transcatheter Aortic Valve Implantation) trial enrolled patients with aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR) pre-treated with aspirin + clopidogrel, aimed to compare the efficacy of clopidogrel and ticagrelor in suppressing high platelet reactivity (HPR) after TAVI. Current recommendations support short-term use of aspirin + clopidogrel for patients with severe AS undergoing TAVR despite the lack of compelling evidence. This was a prospective, randomized, multicenter investigation. Platelet reactivity was measured at 6 different time points with the VerifyNow assay (Accriva Diagnostics, San Diego, California). HPR was defined as (P2Y reaction units (PRU) ≥208. Patients with HPR before TAVR were randomized to either aspirin + ticagrelor or aspirin + clopidogrel for 3 months. Patients without HPR continued with aspirin + clopidogrel (registry cohort). The primary endpoint was non-HPR status (PRU <208) in ≥70% of patients treated with ticagrelor at 90 days post-TAVR. A total of 68 patients were included. Of these, 48 (71%) had HPR (PRU 273 ± 09) and were randomized to aspirin + ticagrelor (n = 24, PRU 277 ± 08) or continued with aspirin + clopidogrel (n = 24, PRU 269 ± 49). The remaining 20 patients (29%) without HPR (PRU 133 ± 12) were included in the registry. Overall, platelet reactivity across all the study time points after TAVR was lower in patients randomized to ticagrelor compared with those treated with clopidogrel, including those enrolled in the registry (p < 0. 001). The primary endpoint was achieved in 100% of patients with ticagrelor compared with 21% with clopidogrel (p < 0. 001). Interestingly, 33% of clopidogrel responder patients at baseline developed HPR status during the first month after TAVR. HPR to clopidogrel is present in a considerable number of patients with AS undergoing TAVR. Ticagrelor achieves a better and faster effect, providing sustained suppression of HPR to these patients. (Platelet Reactivity After TAVI: A Multicenter Pilot Study [REAC-TAVI]; NCT02224066).
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, i la comunicació pública de l'obra, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original. No es permet la creació d'obres derivades.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Antithrombotic therapy ; Aortic stenosis ; High platelet reactivity ; Transcatheter aortic valve replacement ; VerifyNow
Publicat a:	JACC: Cardiovascular Interventions, Vol. 12 Núm. 1 (14 2019) , p. 22-32, ISSN 1876-7605

DOI: 10.1016/j.jcin.2018.10.005
PMID: 30621974

11 p, 1.3 MB

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