Dual vs Single Antiplatelet Therapy After Transcatheter Aortic Valve Replacement for Bioprosthetic Valve Failure

Abstract

Background: Single antiplatelet therapy (SAPT) is the standard treatment after transcatheter aortic valve replacement (TAVR). However, valve-in-valve TAVR to treat surgical bioprosthesis dysfunction carries an increased thrombotic risk and may benefit from more intensive antithrombotic treatment.

Objectives: The aim of this study was to compare the outcomes of patients treated with dual antiplatelet therapy (DAPT) or SAPT in the first year after valve-in-valve TAVR.

Methods: Patients treated with valve-in-valve TAVR at 10 participating centers were included and grouped according to treatment with DAPT or SAPT, while those treated with oral anticoagulant therapy were excluded. Both clinical and echocardiographic outcomes were analyzed at 1-year follow-up. A propensity score was developed, then inverse probability of treatment weighting was applied in HR estimation to account for confounders.

Results: A total of 278 patients were included. No differences between groups were observed for major adverse cardiac and cerebrovascular events (HR: 0.499, 95% CI: 0.182-1.371; P = 0.178), major bleeding (HR: 0.776; 95% CI: 0.172-3.504; P = 0.741), and death (HR: 0.907; 95% CI: 0.272-3.022; P = 0.874). Fewer strokes were observed in patients treated with DAPT (HR: 0.093; 95% CI: 0.010-0.831; P = 0.033). Additionally, there was no significant difference in moderate or severe structural valve deterioration (1.9% vs 6.0%; P = 0.161).

Conclusions: DAPT after valve-in-valve TAVR may be associated with a lower 1-year incidence of stroke, whereas no significant difference was observed for other major ischemic and bleeding outcomes or for premature valve deterioration.

Keywords: antithrombotic treatment; bleeding; stroke; valve deterioration; valve thrombosis; valve-in-valve TAVR.