Background
Guidelines recommend antithrombotic therapy for patients following transcatheter aortic
valve implantation (TAVI) to reduce the risk of ischaemic events and bioprosthetic
valve thrombosis.
Objective
To describe antithrombotic dispensing within 30 days of discharge for Australian patients
receiving TAVI.
Methods
We performed a state-wide retrospective cohort study using linked hospital and medicines
dispensing data from January 2013 to December 2018 for all patients receiving TAVI
in New South Wales, Australia. We identified patients dispensed oral anticoagulants
(vitamin K antagonists [warfarin], direct oral anticoagulants [DOACs]) or clopidogrel
within 30 days of discharge. We examined demographic and clinical predictors of antithrombotic
dispensing.
Results
Our cohort comprised 1,217 patients who underwent TAVI; median age was 84 years and
707 (58.1%) were male. Of these, 808 patients (66.4%) had an antithrombotic dispensed
within 30 days of hospital discharge. One-third (33.7%) of these patients were dispensed
an anticoagulant (16.1% warfarin; 17.6% DOACs) and two-thirds (66.3%) were dispensed
clopidogrel. Patients undergoing TAVI were more likely to be dispensed an antithrombotic
medicine within 30-days of hospital discharge if they had been dispensed antithrombotic
medicines (RR 1.07; 95% CI 1.03–1.11) or angiotensin-converting-enzyme inhibitors/angiotensin
II receptor blockers (RR 1.04; 95% CI 1.00–1.07) in the 6 months prior to admission.
Patients with a history of haemorrhage were less likely to be dispensed an antithrombotic
medicine within 30 days of hospital discharge (RR 0.93; 95% CI 0.89–0.98).
Conclusions
We observed gaps in best evidence pharmacotherapy for patients post-TAVI, with almost
one third of patients not receiving antithrombotic medicines post-discharge. Further
research is needed to quantify the impact of emerging clinical guidelines recommending
single antiplatelet therapy, on adherence to best-practice care.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Heart, Lung and CirculationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Transcatheter aortic valve implantation: a new standard of care.Med J Aust. 2018; 209: 136-141
- 2021 ESC/EACTS Guidelines for the management of valvular heart disease.Eur J Cardiothoracic Surg. 2021; 43: 561-632
- 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.Circulation. 2021; 143: e72-e227
- 2017 ESC/EACTS Guidelines for the management of valvular heart disease.Eur Heart J. 2017; 38: 2739-2791
- Trends in initiation of direct oral anticoagulant therapies for atrial fibrillation in a national population-based cross-sectional study in the French health insurance databases.BMJ Open. 2018; 8e018180
- Evaluation of current practices in transcatheter aortic valve implantation: the WRITTEN (WoRldwIde TAVI ExperieNce) survey.Int J Cardiol. 2017; 228: 640-647
- Antithrombotic therapy in patients undergoing TAVI: an overview of Dutch hospitals.Neth Heart J. 2014; 22: 64-69
- Variation in post-TAVR antiplatelet therapy utilization and associated outcomes: Insights from the STS/ACC TVT Registry.Am Heart J. 2018; 204: 9-16
- Optimal antiplatelet strategy after transcatheter aortic valve implantation: a meta-analysis.Open Heart. 2018; 5e000748
- Evidence-practice gaps in P2Y12 inhibitor use after hospitalisation for acute myocardial infarction: findings from a new population-level data linkage in Australia.Intern Med J. 2020; 52: 249-258
- Evidence-practice gaps in postdischarge initiation with oral anticoagulants in patients with atrial fibrillation.J Am Heart Assoc. 2019; 8e014287
- Antiplatelet therapy within 30 days of percutaneous coronary intervention with stent implantation.Med J Aust. 2020; 213: 124-125
Victorian Agency for Health Information. Delivering better cardiac outcomes in Victoria. Melbourne: 2019. https://www.bettersafercare.vic.gov.au/sites/default/files/2019-06/VAHI%20Delivering%20better%20cardiac%20outcomes%20report_8%20JUNE%202019.pdf. [accessed 31.8.21].
Australian Institute of Health and Welfare. Admitted patient care 2016–17: Australian hospital statistics. Health services series no. 84. Cat. no. HSE 201. Canberra: 2018. https://www.aihw.gov.au/getmedia/acee86da-d98e-4286-85a4-52840836706f/aihw-hse-201.pdf.aspx?inline=true. [accessed 31.8.21].
- The Australian Pharmaceutical Benefits Scheme data collection: a practical guide for researchers.BMC Res Notes. 2015; 8: 634
- The international statistical classification of diseases and related health problems, tenth revision, australian modification (ICD-10-AM/ACHI/ACS).Australian Consortium for Classification Development, Darlinghurst, NSW2017https://www.ihpa.gov.au/what-we-do/ICD-10-AM/ACHI/ACS-classification-systemDate accessed: June 20, 2020
Department of Health. 2. Prescribing Medicines – Information for PBS Prescribers. Canberra: 2015. https://www.pbs.gov.au/info/healthpro/explanatory-notes/section1/Section_1_2_Explanatory_Notes#Restrictions. [accessed 31.8.21].
- Expert position paper on the use of proton pump inhibitors in patients with cardiovascular disease and antithrombotic therapy.Eur Heart J. 2013; 34: 1708-1713
Australian Bureau of Statistics. 2039.0 - Information Paper: An Introduction to Socio-Economic Indexes for Areas (SEIFA), 2006. Canberra: 2008. https://www.abs.gov.au/ausstats/[email protected]/mf/2039.0. [accessed 31.8.21].
Australian Institute of Health and Welfare. Regional and remote health: A guide to remoteness classifications. Canberra: 2004. https://www.aihw.gov.au/reports/rural-remote-australians/guide-to-remoteness-classifications/summary. [accessed 31.7.21].
- New ICD-10 version of the Charlson comorbidity index predicted in-hospital mortality.J Clin Epidemiol. 2004; 57: 1288-1294
- Development and validation of a Hospital Frailty Risk Score focusing on older people in acute care settings using electronic hospital records: an observational study.Lancet. 2018; 391: 1775-1782
- A modified Poisson regression approach to prospective studies with binary data.Am J Epidemiol. 2004; 159: 702-706
- Evaluating medication effects outside of clinical trials: new-user designs.Am J Epidemiol. 2003; 158: 915-920
- Misclassification in administrative claims data: quantifying the impact on treatment effect estimates.Curr Epidemiol Reports. 2014; 1: 175
- Antithrombotic therapy after transcatheter aortic valve replacement.Circ Cardiovasc Interv. 2019; 12e007411
- The impact of hypo-attenuated leaflet thickening on haemodynamic valve deterioration following transcatheter aortic valve replacement.J Cardiovasc Comput Tomogr. 2021; 16: 168-173
- Subclinical leaflet thrombosis after transcatheter aortic valve replacement: a meta-analysis.JACC Cardiovasc Interv. 2021; 14: 2643-2656
- Prevalence, predictors, and outcomes of primary nonadherence after acute myocardial infarction.Circulation. 2008; 117: 1028-1036
- Aspirin with or without clopidogrel after transcatheter aortic-valve implantation.N Engl J Med. 2020; 383: 1447-1457
- Aspirin versus aspirin plus clopidogrel as antithrombotic treatment following transcatheter aortic valve replacement with a balloon-expandable valve: the ARTE (Aspirin Versus Aspirin+ Clopidogrel Following Transcatheter Aortic Valve Implantation) randomiz.JACC Cardiovasc Interv. 2017; 10: 1357-1365
- A controlled trial of rivaroxaban after transcatheter aortic-valve replacement.N Engl J Med. 2020; 382: 120-129
- Anti-thrombotic strategy to lower all cardiovascular and neurologic ischemic and hemorrhagic events after TransAortic Valve Implantation for Aortic Stenosis: a randomized, open-label, phase 3 trial [Conference presentation].American College of Cardiology Virtual Annual Scientific Session (ACC 2021). 2021; (In preparation)
- Edoxaban versus vitamin K antagonist for atrial fibrillation after TAVR.N Engl J Med. 2021; 385: 2150-2160
Pharmaceutical Benefits Scheme. Australian statistics on medicines 2015. 2016. https://www.pbs.gov.au/statistics/asm/2015/australian-statistics-on-medicines-2015.pdf. [accessed 30.6.21].
Article info
Publication history
Published online: May 27, 2022
Accepted:
April 26,
2022
Received in revised form:
March 29,
2022
Received:
January 13,
2022
Identification
Copyright
© 2022 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.
