Predictors and Prevalence of Stroke after TAVI Depending on Antithrombotic Therapy

Background: The number of transcatheter aortic-valve implantations (TAVI) is increasing tremendously, whereas the post-procedural antithrombotic management after TAVI is undetermined. Aim of this study is to identify predictors of post-procedural stroke after TAVI with respect to the antithrombotic regimen. Methods and results: Data from 300 consecutive patients who underwent TAVI at our institution between August 2008 and February 2012 were included in this observational study. The mean age was 82.1 ± 0.3, the logistic EuroScore I was 24.34 ± 0,8. The decision on the post-procedural antithrombotic therapy was left to the operator. From 255 patients that were discharged alive 13 were re-hospitalized due to an ischemic stroke (5.1%). There were no significant differences in the baseline characteristics between patients with stroke and without stroke. In particular diabetes, renal insufficiency, prior cerebral ischemic events, peripheral vascular disease and coronary artery disease were not predictive for the occurrence of strokes. Importantly, the prevalence of atrial fibrillation was 61.5% in the stroke group and 43.4% in the no-stroke group (P=0.19). The CHAD2DS2-VASc scores in the two groups were similar (stroke: 5,68; no-stroke: 5.92). Patients with post-procedural stroke received significantly more often a single antithrombotic therapy (either single antiplatelet or single anticoagulation) than patients without stroke (61.5% vs. 27.3%; P=0.02). In the no-stroke group patients received more often dual antiplatelet therapy (41.3% vs. 15.4%) or a combination of antiplatelet and anticoagulative therapy (27.7% vs. 15.4%). Conclusion: TAVI patients treated with a combinated antithrombotic therapy may be better protected against stroke than patients with a single antithrombotic therapy.