Clinical Outcomes of TAVR Patients on DAPT vs. SAPT with Prior or New Gastrointestinal Bleeding

Background Gastrointestinal [GI] bleeding is a common late complication [>30 days] in Transcatheter Aortic Valve Replacement [TAVR] patients, associated with poorer long-term prognosis and mortality. Its management is complex, often requiring gastroenterology consultation. Risk factors include age, comorbidities, antiplatelet use, and altered hemodynamics, which complicate endoscopic procedures. Patients with prior GI bleeding may face delays or ineligibility for TAVR. Objectives This study aims to determine [a] whether a history or new onset of GI bleeding impacts clinical outcomes in TAVR patients on antiplatelet therapy, and [b] if selecting single antiplatelet therapy [SAPT] over DAPT worsens adverse cardiac events in patients with GI bleeds. Methods We conducted a retrospective chart review of TAVR patients from 2018-2021 at a tertiary medical center [n=470]. Patients with prior stents or anticoagulant indications were excluded [n=214]. The primary outcome was comparing adverse cardiac events in patients with and without GI bleeds. Secondary outcomes included rates and types of postoperative GI and non-GI bleeds, bleeding interventions, and all-cause mortality. Results Among patients, 3.6% on DAPT, 25% on aspirin, and 17.6% on clopidogrel had a history or developed a new GI bleed. No significant differences in adverse cardiac events were observed between those with and without GI bleeds or between SAPT and DAPT groups. Conclusions History of GI bleeds and post-TAVR anti-platelet therapy selection does not impact adverse cardiac outcomes.