Aspirin/clopidogrel withdrawal
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Increase in transaortic gradients and heart failure symptoms in an elderly patient: case report A 72-year-old man developed a transient increase in transaortic pressure gradients with heart failure symptoms after discontinuing dual antiplatelet therapy with aspirin and clopidogrel. The man underwent transcatheter aortic valve implantation for severe symptomatic aortic valve stenosis. Upon discharge, he was prescribed dual antiplatelet therapy with aspirin and clopidogrel [dosages and routes not stated]. At 6 months follow-up, he displayed a new, sudden increase in heart failure symptoms, particularly dyspnoea. Echocardiography disclosed a nearly four-fold increase in mean transaortic gradient and thickened leaflet tips with impaired proper opening. It was subsequently revealed that dual antiplatelet therapy had been discontinued prematurely by his general practitioner after 4 months. Dual antiplatelet therapy was resumed. The man’s pressure gradients decreased over the following 3 months. His heart failure symptoms subsided and his pressure gradients were stable after 3 years. He was prescribed lifetime dual antiplatelet therapy. Author comment: "One possible explanation for the functional and structural bioprosthetic valve alterations observed in our patient might be . . . microthrombi formation on the nonendothelialized surface of the bovine pericardial tissue leaflets . . . The positive effect of resumption of dual antiplatelet therapy might favor [this] hypothesis." Al-Rashid F, et al. Transient increase in pressure gradients after termination of dual antiplatelet therapy in a patient after transfemoral aortic valve implantation. Circulation: Cardiovascular Interventions 5: 318-20, No. 2, Apr 2012 803078238 Germany
0114-9954/10/1423-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Reactions 13 Oct 2012 No. 1423
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