Key result
Dual antiplatelet therapy post-TAVR was associated with a higher risk of death or ischemia compared to single antiplatelet therapy (aHR 1.41; 95% CI 1.01-1.96; p=0.041).
Why the study?
There are limited data regarding the optimal antiplatelet and antithrombotic therapy following transcatheter aortic valve replacement.
Does dual antiplatelet therapy or oral anticoagulation compared to single antiplatelet therapy or no OAC improve outcomes in patients post-TAVR?
Cohort (n=492)
No
Does dual antiplatelet therapy or oral anticoagulation compared to single antiplatelet therapy or no OAC improve outcomes in patients post-TAVR?
Hazard Ratio: 1.41 (95% CI 1.01–1.96)
Absolute Event Rate: 23.6% vs 14.8%
p-value: p=.041
Routine use of DAPT post-TAVR is associated with increased death or ischemia compared to SAPT, and OAC increases major bleeding risk.
May favor single over dual antiplatelet therapy post-TAVR; leaves open confirmation in randomized trials.
BACKGROUND: There are limited data regarding optimal antiplatelet/antithrombotic therapy following transcatheter aortic valve replacement (TAVR). METHODS: In this single-centre retrospective study including TAVR patients from 2012 to 2020, ischemic and bleeding outcomes were compared between antiplatelet (dual antiplatelet [DAPT] vs. single antiplatelet [SAPT]) and oral anticoagulation (OAC) groups using incidence rate, Kaplan-Meier and Cox proportional hazards analysis. RESULTS: Total 492 patients (mean age 79.7 ± 7.7 years, 53.7% males, 83.5% Caucasian) were included. There was higher incidence of 1-year death or ischemia with DAPT vs. SAPT (23.6 vs. 14.8 per 100 patient-years [PY], incidence rate ratio [IRR] 1.60, 95% confidence interval [CI] 0.97-2.68, p = .05), especially in those without coronary artery disease (23.9 vs. 10.7 per 100 PY, IRR 2.24, 95% CI 1.10-4.47, p = .017). There was significantly higher major bleeding in those on OAC vs. no OAC (15 vs. 8 per 100 PY, IRR 1.87, 95% CI 1.10-3.11, p = .016), especially late (>1-year) bleeding (10.2 vs. 3.6 per 100 PY, IRR 2.81, 95% CI 1.33-5.92, p = .004). In multivariate analysis, DAPT was an independent predictor of death or ischemia (adjusted hazard ratio [aHR] 1.41, 95% CI 1.01-1.96, p = .041). OAC was an independent predictor of major bleeding (aHR 2.32, 95% CI 1.31-4.13, p = .004). CONCLUSIONS: There is signal to harm with routine use of DAPT post-TAVR. There is higher incidence of late bleeding post-TAVR with OAC, suggesting potential role for alternate antithrombotic strategies.
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Moey et al. (2023) conducted a cohort in post-transcatheter aortic valve replacement (TAVR) (n=492). Dual antiplatelet therapy (DAPT) vs. Single antiplatelet therapy (SAPT) was evaluated on death or ischemia (aHR 1.41, 95% CI 1.01-1.96, p=.041). Dual antiplatelet therapy post-TAVR was associated with a higher risk of death or ischemia compared to single antiplatelet therapy (aHR 1.41; 95% CI 1.01-1.96; p=0.041).
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