Transcatheter Aortic Valve Replacement Medication

Updated: Dec 07, 2015
  • Author: Ramin Assadi, MD; Chief Editor: Eric H Yang, MD  more...
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Medication

Medication Summary

The objectives of pharmacotherapy are to prepare the patient for the procedure, to prevent complications, and reduce morbidity.

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Antiplatelet Agents

Class Summary

It inhibits prostaglandin synthesis, which prevents the formation of platelet-aggregating thromboxane A2.

Clopidogrel (Plavix)

Clopidogrel selectively inhibits adenosine diphosphate (ADP) binding to platelet receptors and subsequent ADP-mediated activation of the glycoprotein (GP) IIb/IIIa complex, thereby inhibiting platelet aggregation. Antiplatelet therapy with aspirin (162-325 mg) and clopidogrel (300 mg) is started at least 24 hours prior to transcatheter aortic valve implantation.

Aspirin (Bayer Aspirin, Ascriptin Maximum Strength, Ecotrin, Bufferin)

Patients are pretreated with aspirin (81-325 mg) daily and clopidogrel 300-mg loading dose at least one hour prior to the procedure and continued at 81-mg oral daily dose. Antiplatelet therapy with aspirin (162-325 mg) and clopidogrel (300 mg) is started at least 24 hours prior to transcatheter aortic valve implantation.

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Antibiotics

Class Summary

Prophylactic intravenous antibiotic therapy at least 1 hour before the procedure is also recommended.

Cefuroxime (Ceftin, Zinacef)

Cefuroxime is a second-generation cephalosporin that maintains the gram-positive activity of first-generation cephalosporins; it adds activity against Proteus mirabilis, Haemophilus influenzae, E coli, Klebsiella pneumoniae, and Moraxella catarrhalis.

The dose is repeated 6 and 12 hours after the procedure. In patients who are allergic to penicillin (or cephalosporins), vancomycin may be considered.

Vancomycin

This is a potent antibiotic that is directed against gram-positive organisms and is active against enterococcal species. Vancomycin is used in conjunction with for prophylaxis in penicillin-allergic patients. Dose adjustment may be necessary in patients with renal impairment.

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