Aspirin use and transcutaneous pulmonary valve replacement, the need for consistency
Presenter
Kamel Shibbani, M.D., University of Iowa Stead Family Children’s Hospital, Iowa City, IA
Kamel Shibbani, M.D.1, Ruchira Garg, MD2, Evan M. Zahn, MD, MSCAI2 and Daniel Mclennan, M.B.B.S.3, (1)University of Iowa Stead Family Children’s Hospital, Iowa City, IA, (2)Cedars-Sinai Medical Center, Los Angeles, CA, (3)Children's Wisconsin, Milwaukee, WI
Keywords: Congenital Heart Disease (CHD), Pharmacotherapy, Right Ventricular Outflow Tract (RVOT) and TPVR/Pulmonary Valve
Background
Transcatheter pulmonary valves are a mainstay in pediatric interventional catheterization labs. Their meteoric rise to fame has come with certain complications, including infection and early valve failure. Though these complications have been mitigated through the use of Aspirin to limit thrombi, we cannot help but question if we are doing enough.
Methods
A recent survey was sent out to pediatric interventional cardiologists globally through PICS and CCISC to ascertain prescription habits of Aspirin as an antithrombotic after transcatheter pulmonary valve replacement (TPVR).
Results
We had 109 responses. There was significant discrepancy in dose, type and duration of Aspirin as well as antithrombotic teaching as it relates to antithrombotic effects of Aspirin. Although there was unanimity in initiating Aspirin therapy after TPVR, 23.58% of responders prescribed a second agent while 75% felt that Aspirin is enough. Meanwhile, 11.2% of responders specifically prescribed enteric coated Aspirin, 78.5% did not specify type, and only 11.0 % prescribed non-enteric coated Aspirin. Only 3.74% of responders consistently counsel against the use of PPI, while 86% do not. Exactly two-thirds of our responders did not counsel patients about the need to avoid other NSAIDs. Regarding dose, 56% reported that a fixed dose of 70-100mg is appropriate regardless of weight while 28% use a weight-based dose of 4-5 mg/kg. Only 7.5% of responders used 325 mg regardless of weight and the rest reported a mixture of doses depending on time post-TPVR.
Conclusions
The survey we administered highlighted the lack of consensus around the appropriate Aspirin regimen post TPVR.
