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July 18, 2026Cardiovascular Drugs and TherapyOpen Access

Combination antithrombotics after valve-in-valve TAVI linked to ~176% higher MACCE risk vs single antiplatelets.

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Why the study?

Valve-in-valve transcatheter aortic valve implantation is a less invasive alternative to redo surgery for failed surgical bioprostheses, but optimal antithrombotic management is uncertain.

Does oral anticoagulation (alone or with antiplatelets) improve clinical outcomes compared to antiplatelet-only therapy in adults following valve-in-valve TAVI?

Population

1,050 adults undergoing valve-in-valve transcatheter aortic valve implantation in the Australasian Cardiac Outcomes Registry

Comparison

Single antiplatelet therapy vs dual antiplatelet therapy vs oral anticoagulation vs oral anticoagulation plus antiplatelet therapy

Design

Registry-based observational cohort study

Follow-up

12 months

Key result

Combination antithrombotic therapy following valve-in-valve TAVI was associated with a significantly higher risk of 12-month MACCE compared to single antiplatelet therapy (OR 2.76), likely reflecting greater baseline comorbidity burden.

Authors

EDEdward DababnehMMMaría Gabriela MattaASAjay Sinhal

Discussion

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Overview

Supports caution with combination therapy; leaves open confirmation in randomized trials.

Key Points

  • The study aims to compare outcomes of different antithrombotic therapies following valve-in-valve transcatheter aortic valve implantation.
  • Retrospective analysis using the Australasian Cardiac Outcomes Registry (2018–2025) with 1,050 adults.
  • Grouped by discharge antithrombotic regimens: single antiplatelet, dual antiplatelet, oral anticoagulation, and combination therapy.
  • Outcomes assessed included mortality, stroke, major bleeding, and echocardiographic valve performance.
  • 30-day mortality: 1.7% with oral anticoagulation and 3.6% with combination therapy vs. 0% with antiplatelet therapies (p < 0.001).
  • 30-day MACCE rates were higher with oral anticoagulation (4.5%) and combination therapy (4.4%) compared to single (1.5%) and dual antiplatelet therapy (0.4%) (p = 0.003).
  • At 12 months, MACCE rates remained highest for oral anticoagulation (11.8%) and combination therapy (10.7%).

Study Design

Type

Cohort (n=1,050)

Multicenter

Yes

Structured PICO

Does oral anticoagulation (alone or with antiplatelets) improve clinical outcomes compared to antiplatelet-only therapy in adults following valve-in-valve TAVI?

P
Population
1,050 older adults undergoing valve-in-valve transcatheter aortic valve implantation for degenerated bioprostheses, followed for 12 months to compare real-world antithrombotic regimens.
E
Exposure
Oral anticoagulation alone or in combination with antiplatelet therapy at discharge
C
Comparator
Single antiplatelet therapy (SAPT) or dual antiplatelet therapy (DAPT) at discharge
O
Outcome
30-day and 12-month mortality, stroke/TIA, life-threatening or major bleeding, major adverse cardiac and cerebrovascular events (MACCE), and echocardiographic valve performancecomposite

Main Result

Odds Ratio: 2.76 (95% CI 1.03–7.37)

Absolute Event Rate: 10.7% vs 5%

p-value: p=0.043

Following valve-in-valve TAVI, discharge on oral anticoagulation-containing regimens is associated with higher early mortality and 12-month MACCE compared to antiplatelet-only strategies, though this likely reflects baseline confounding rather than a direct treatment effect.

Limitations

  • Non-randomised observational design with potential selection bias and confounding by indication
  • Exact dates of clinical events were not available, precluding time-to-event analyses
  • Echocardiographic follow-up at 12 months was incomplete (available in only 52% of patients)
  • Lack of cardiac computed tomography precluded assessment of hypo-attenuated leaflet thickening (HALT)
  • Registry did not capture specific indications for OAC, proportion of VKA vs DOAC, or duration of concomitant antiplatelet therapy
  • Associations likely reflect in part the greater baseline comorbidity burden of patients prescribed anticoagulation rather than a direct treatment effect (confounding by indication)

Cite This Study

Dababneh et al. (2026) conducted a cohort in Degenerated bioprosthetic aortic valves requiring valve-in-valve TAVI (n=1,050). Combination therapy (oral anticoagulation plus antiplatelet) vs. Single antiplatelet therapy (SAPT) was evaluated on 12-month Major Adverse Cardiac and Cerebrovascular Events (MACCE) (OR 2.76, 95% CI 1.03-7.37, p=0.043). Combination antithrombotic therapy following valve-in-valve TAVI was associated with a significantly higher risk of 12-month MACCE compared to single antiplatelet therapy (OR 2.76), likely reflecting greater baseline comorbidity burden.

synapsesocial.com/papers/6a5b18d718557b26c203a950https://doi.org/10.1007/s10557-026-07914-2
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