Key result
SAPT after TAVR is linked to ~41% lower 6-month mortality vs DAPT.
Why the study?
Guidelines recommend SAPT over DAPT after TAVR based on reduced bleeding risk, but data regarding mortality have remained inconclusive.
Does single antiplatelet therapy reduce all-cause mortality compared to dual antiplatelet therapy in patients undergoing femoral TAVR without an indication for anticoagulation?
Cohort (n=5,514)
Yes
Does single antiplatelet therapy reduce all-cause mortality compared to dual antiplatelet therapy in patients undergoing femoral TAVR without an indication for anticoagulation?
In patients undergoing TAVR without an indication for anticoagulation, single antiplatelet therapy is associated with significantly lower all-cause mortality and major bleeding at 6 and 24 months compared to dual antiplatelet therapy.
DAPT was associated with higher post-TAVR mortality; hypothesis-generating and should not yet change practice.
BACKGROUND: Current guidelines recommend single antiplatelet therapy (SAPT) after transcatheter aortic valve replacement (TAVR) in patients without an indication for anticoagulation. This recommendation is mainly based on a better risk profile in terms of bleeding over dual antiplatelet therapy (DAPT), although data on mortality are inconclusive. OBJECTIVES: We analyzed 6-month and 24-month mortality associated with SAPT and DAPT after femoral TAVR from the Transfusion Requirements in Transcatheter Aortic Valve Implantation registry. METHODS: The Transfusion Requirements in Transcatheter Aortic Valve Implantation is a multicenter registry including 10,071 patients undergoing TAVR. For the purpose of the present study, 4,557 patients with indication to anticoagulation, nonfemoral access, recent percutaneous coronary intervention, and procedural complications were excluded. The remaining 5,514 patients (age 81 ± 7 years, 51% males) were discharged either on SAPT (n = 3,197) or DAPT (n = 2,317). RESULTS: The SAPT group, compared with the DAPT group, experienced lower 6-month all-cause mortality (2.4% vs 5.4%; log-rank P < 0.0001) and major bleeding (0.5% vs 1.3%; log-rank P = 0.001). SAPT was associated with reduced both cardiovascular (1.3%) and noncardiovascular mortality (1.1%), as compared to DAPT (2.2%, P = 0.008 and 3.2%, P = 0.0001, respectively). At 24-month follow-up, overall mortality remained significantly lower with SAPT vs DAPT (11.7% vs 14.2%; log-rank P = 0.007). Cox regression hazard model confirmed the association of DAPT with 6-month (adjusted HR: 1.69; 95% CI: 1.20-2.37; P = 0.002) and 24-month (adjusted HR: 1.21; 95% 1.01-1.46; P = 0.04) all-cause mortality. CONCLUSIONS: In a large real-world population of all comers undergoing TAVR, SAPT was associated with a significantly lower 6-month and 24-month all-cause mortality as compared with DAPT. (Transfusion Requirements in Transcatheter Aortic Valve Implantation [TRITAVI] Study; NCT03740425).
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Pelliccia et al. (2026) conducted a cohort in Transcatheter Aortic Valve Replacement (n=5,514). Single antiplatelet therapy (SAPT) vs. Dual antiplatelet therapy (DAPT) was evaluated on 6-month all-cause mortality (adjusted HR 1.69, 95% CI 1.20-2.37, p=0.002). Single antiplatelet therapy after TAVR was associated with significantly lower 6-month all-cause mortality compared to dual antiplatelet therapy (2.4% vs 5.4%; P<0.0001).
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