Optimal antiplatelet and antithrombotic regimen post‐transcatheter aortic valve replacement

Abstract

AbstractBackgroundThere are limited data regarding optimal antiplatelet/antithrombotic therapy following transcatheter aortic valve replacement (TAVR).MethodsIn 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.ResultsTotal 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).ConclusionsThere 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.