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Antithrombotic Treatment after Percutaneous Coronary or Aortic Valve Interventions

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Vascular Medicine".

Deadline for manuscript submissions: closed (15 December 2018) | Viewed by 12010

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Special Issue Editor

Dr. Sabato Sorrentino

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Guest Editor

1. Interventional Cardiovascular Research and Clinical Trials, ICAHN School of Medicine at Mount Sinai, New York, NY, USA
2. The Zena and Michael A. Wiener Cardiovascular Institute, One Gustave L. Levy Place, Box 1030, New York, NY 10029-6574, USA
Interests: coronary physiology; acute coronary syndrome; thrombosis; restenosis; hypertension; anticoagulants; non-coding RNA

Special Issue Information

Dear Colleagues,

Dual antiplatelet therapy (DAPT) with aspirin and P2Y12 receptor inhibitors is the cornerstone of medical treatment after percutaneous coronary intervention (PCI) and stent implantation, aiming to decrease the risk of coronary stent-related and non-related thrombotic events. On the other hand, this strategy also increases the risk of bleeding over time. Of note, coronary thrombotic events and bleeding are associated with mortality risks of comparable magnitude after PCI, findings that should be taken into account in the risk/benefit calculations for extension versus discontinuation of DAPT. However, despite a large number of studies, the duration of DAPT remain unclear, in particular for patients at high risks, such as patients undergoing non-cardiac surgery, with history of malignancy or with recurrent coronary thrombotic events. Similarly, antithrombotic treatment is of paramount importance in patients undergoing transcatheter aortic valve replacement (TAVR) because of the increasing risk of valve thrombosis and thromboembolic events after procedure. The introduction in clinical practice of new generation devices and antithrombotic agents offer a broader spectrum of therapeutic options after PCI and TAVR procedures. This Special Issue will summarize new recommendations on optimal DAPT duration and decision-making tools in patients undergoing TAVR or PCI, based on original articles and systematic reviews.

Dr. Sabato Sorrentino
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

Antithrombotic treatment
Percutaneous coronary intervention
Aortic valve intervention
Dual antiplatelet therapy
Stent implantation
Coronary thrombosis
Bleeding
Cardiosurgery

Published Papers (3 papers)

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Research

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9 pages, 611 KiB

Open AccessArticle

Procedural Predictors for Bioresorbable Vascular Scaffold Thrombosis: Analysis of the Individual Components of the “PSP” Technique

by Zisis Dimitriadis, Alberto Polimeni, Remzi Anadol, Martin Geyer, Melissa Weissner, Helen Ullrich, Thomas Münzel and Tommaso Gori

J. Clin. Med. 2019, 8(1), 93; https://doi.org/10.3390/jcm8010093 - 15 Jan 2019

Cited by 8 | Viewed by 2184

Abstract

The technique used at the time of implantation has a central role in determining the risk of thrombosis in bioresorbable vascular scaffolds (BRS). Different definitions of the “optimal” implantation technique exist, however. The impact of individual procedural characteristics on the risk of scaffold thrombosis (ScT) was evaluated in a single-center observational study that enrolled 657 patients (79% males, mean age 63 ± 12 years) with 763 lesions who received a total of 925 BRS for de novo lesions. During a median 1076 (762–1206) days’ follow-up there were 28 cases of thrombosis. Independent predictors of ScT included the use of predilatation balloons bigger than the nominal BRS diameter (hazard ratio (HR) = 0.4 (0.16–0.98), p = 0.04), sizing (implantation in vessels with reference vessel diameter >3.5 mm or <2.5 mm: HR = 5.71 (2.32–14.05), p = 0.0002) and the degree of vessel expansion (ratio of minimum lumen to reference vessel diameter, HR: 0.005 (0.0001–0.23), p = 0.007). In addition, a mild BRS oversizing (final BRS diameter to vessel diameter 1.14–1.28) was associated with a lower thrombosis risk, whereas undersizing and more severe oversizing (final BRS diameter to vessel diameter <1.04 and >1.35, respectively) were associated with an increased risk of ScT (HR = 0.13 (0.02–0.59), p = 0.0007). In conclusion, different components of the “optimal” technique have different impacts on the risk of BRS thrombosis. Besides predilatation with a balloon larger than the BRS diameter, correct vessel size selection and a mild to moderate oversizing appear to be protective. Full article

(This article belongs to the Special Issue Antithrombotic Treatment after Percutaneous Coronary or Aortic Valve Interventions)

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12 pages, 1353 KiB

Open AccessArticle

Serum Renalase Levels Are Predicted by Brain-Derived Neurotrophic Factor and Associated with Cardiovascular Events and Mortality after Percutaneous Coronary Intervention

by I-Te Lee and Wayne Huey-Herng Sheu

J. Clin. Med. 2018, 7(11), 437; https://doi.org/10.3390/jcm7110437 - 12 Nov 2018

Cited by 9 | Viewed by 3436

Abstract

Circulating brain-derived neurotrophic factor (BDNF) predicts survival rate in patients with coronary artery disease (CAD). We examined the relationship between BDNF and renalase before and after percutaneous coronary intervention (PCI) and the role of renalase in patients with CAD. Serum BDNF and renalase levels were determined using blood samples collected before and after PCI. Incident myocardial infarction, stroke, and mortality were followed up longitudinally. A total of 152 patients completed the assessment. BDNF levels were not significantly changed after PCI compared to baseline levels (24.7 ± 11.0 vs. 23.5 ± 8.3 ng/mL, p = 0.175), although renalase levels were significantly reduced (47.5 ± 17.3 vs. 35.9 ± 11.3 ng/mL, p < 0.001). BDNF level before PCI was an independent predictor of reduction in renalase (95% confidence interval (CI): −1.371 to −0.319). During a median 4.1 years of follow-up, patients with serum renalase levels of ≥35 ng/mL had a higher risk of myocardial infarction, stroke, and death than those with renalase of <35 ng/mL (hazard ratio = 5.636, 95% CI: 1.444–21.998). In conclusion, our results show that serum BDNF levels before PCI were inversely correlated with the percentage change in renalase levels after PCI. Nevertheless, post-PCI renalase level was a strong predictor for myocardial infarction, stroke, and death. Full article

(This article belongs to the Special Issue Antithrombotic Treatment after Percutaneous Coronary or Aortic Valve Interventions)

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Review

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16 pages, 429 KiB

Open AccessReview

Thromboembolic and Bleeding Complications in Transcatheter Aortic Valve Implantation: Insights on Mechanisms, Prophylaxis and Therapy

by Mark P. Ranasinghe, Karlheinz Peter and James D. McFadyen

J. Clin. Med. 2019, 8(2), 280; https://doi.org/10.3390/jcm8020280 - 25 Feb 2019

Cited by 35 | Viewed by 6023

Abstract

Transcatheter aortic valve implantation (TAVI) has emerged as an important alternative to surgical aortic valve repair (SAVR) for patients with severe aortic stenosis. This rapidly advancing field has produced new-generation devices being delivered with small delivery sheaths, embolic protection devices and improved retrieval features. Despite efforts to reduce the rate of thrombotic complications associated with TAVI, valve thrombosis and cerebral ischaemic events post-TAVI continue to be a significant issue. However, the antithrombotic treatments utilised to prevent these dreaded complications are based on weak evidence and are associated with high rates of bleeding, which in itself is associated with adverse clinical outcomes. Recently, experimental data has shed light on the unique mechanisms, particularly the complex haemodynamic changes at sites of TAVI, that underpin the development of post-TAVI thrombosis. These new insights regarding the drivers of TAVI-associated thrombosis, coupled with the ongoing development of novel antithrombotics which do not cause bleeding, hold the potential to deliver newer, safer therapeutic paradigms to prevent post-TAVI thrombotic and bleeding complications. This review highlights the major challenge of post-TAVI thrombosis and bleeding, and the significant issues surrounding current antithrombotic approaches. Moreover, a detailed discussion regarding the mechanisms of post-TAVI thrombosis is provided, in addition to an appraisal of current antithrombotic guidelines, past and ongoing clinical trials, and how novel therapeutics offer the hope of optimizing antithrombotic strategies and ultimately improving patient outcomes. Full article

(This article belongs to the Special Issue Antithrombotic Treatment after Percutaneous Coronary or Aortic Valve Interventions)

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