Ticagrelor is more effective than clopidogrel at suppressing high platelet reactivity after transcatheter aortic valve implantation (TAVI). More than two thirds of patients undergoing TAVI have high platelet reactivity, and clopidogrel does not provide adequate platelet inhibition before or after the procedure in most patients. Over one third of patients who were initially responsive to clopidogrel became non-responsive in the first month after TAVI. In contrast, ticagrelor was effective at suppressing high platelet reactivity in over 90% of patients at 6 hours and 100% at 5 days after TAVI, and maintained this effect during the 3 months following the procedure, with no increase in bleeding

1. Introducción
Diseño

2. Resultados

3. Conclusiones
High platelet reactivity is present in more than 2/3 of patients with AS undergoing TAVI
Clopidogrel does not achieve an adequate platelet inhibition before and after TAVI in most of the patients
More than 1/3 of patients initially clopidogrel responders become non-responders during the first month after TAVI
Ticagrelor is effective for the suppression of high platelet reactivity after TAVI with maintenance of its effect
during the three months following TAVI
ü >90% of responders at 6 hrs and 100% at 5 days after TAVI
No differences in mortality and incidence of bleeding complications between groups were noted
Why is this important?
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o AS + TAVI = inflammation, platelet activation, thrombogenicity, calcification
o Adequate antiplatelet effect does not seem to be achieved in all TAVI patients with current recommended DAPT
o The role of HPR in the development of thrombotic events after TAVI / SAVR deserve proper evaluation
o It is worth studying new pharmacological treatment alternatives in this clinical context and its effect in major events
(clinical and subclinical thrombosis, bleeding)

4. REAC TAVI 2:
o RCT with >1000 pts
o DAPT vs SAPT
o 3 european countries
o Clinical endpoints
AGRADECIMIENTO A LOS INVESTIGADORES PARTICIPANTES:
-H. Alvaro Cunqueiro, Vigo: Andrés Íñiguez, J.A. Baz, Alberto
Ortiz, Saleta Fernandez, A. De Miguel, G. Bastos, Victor Jimenez
-H. Virgen de la Arrixaca, Murcia: Mariano Valdes, Antonio Tello,
Eduardo Pinar, Juan Garcia de Lara
-H. Universitario La Paz, Madrid: Raúl Moreno, Guillermo
Galeote, Daniele Gemma
-H. Universitario de Salamanca: Ignacio Cruz, Alejandro Diego,
Javier Martin Moreiras
-H. Virgen de las Nieves, Granada: Eduardo Molina
-H. de Bellvitge, Barcelona: Angel Cequier, Rafa Romaguera
-H. Sant Pau, Barcelona: Antonio Serra, Livia George