Valve-in-valve transcatheter aortic valve intervention (TAVI) is also more frequently utilized to treat failed surgical bioprosthetic valves in patients with severe aortic valve disease. Single antiplatelet therapy (SAPT) remains the standard post-TAVI regimen, but valve-in-valve procedures are at greater risk for thrombosis and embolic complications, this study was pursued as to whether DAPT would provide superior protection. This multicenter study aimed to elucidate if DAPT enhances one-year outcomes over SAPT in patients with valve-in-valve TAVI.
There were 278 patients enrolled in this multicenter study who had undergone valve-in-valve TAVI in 10 centres participating in the study. The patients were randomized into two groups: those taking dual antiplatelet therapy (DAPT) and those taking single antiplatelet therapy (SAPT). Oral anticoagulant therapy patients were excluded to prevent confounding effects. Both clinical and echocardiographic results were measured during a one-year follow-up. A propensity score model was used to control for baseline imbalances, and inverse probability of treatment weighting (IPTW) was used to estimate hazard ratios (HRs) for the major outcomes. Major adverse cardiac and cerebrovascular events (MACCE), major bleeding, stroke, and all-cause mortality were primary endpoints. Secondary analysis compared structural valve deterioration.
Results
The outcomes revealed no statistically significant differences between the SAPT and DAPT groups regarding the composite rate of 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), or mortality (HR 0.907; 95% CI 0.272–3.022; P=0.874).
Yet, there was a significantly lower rate of stroke among DAPT-treated patients compared to SAPT-treated patients (HR 0.093; 95% CI 0.010–0.831; P=0.033), implying a neuroprotective effect.
The frequencies of moderate or severe structural valve deterioration were infrequent and not statistically significantly different between the groups (1.9% vs 6.0%; P=0.161).
The present multicenter study revealed that DAPT following valve-in-valve TAVI was linked to a significantly reduced one-year incidence of stroke when compared with SAPT, without a rise in the risks of bleeding, mortality, or valve deterioration. Thus, DAPT can be considered in patients with greater stroke risk, but this will require confirmation from larger randomized studies in this niche patient population on its optimal use and long-term effects.
Reference:
Bendandi, F., Palmerini, T., De Marco, F., Godino, C., Fraccaro, C., Barbanti, M., Biroli, M., Gaspardone, C., Gandolfo, C., Annibali, G., Costa, G., Rubboli, A., Tarantino, F. F., Moretti, C., Cavazza, C., Compagnone, M., Gennari, M., Cannata, S., Zimarino, M., … Saia, F. (2025). Dual versus single antiplatelet therapy after transcatheter aortic valve implantation for bioprosthetic valve failure. JACC. Cardiovascular Interventions. https://doi.org/10.1016/j.jcin.2025.09.018
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