No antithrombotic therapy okay for select TAVR patients: Data from OCEAN-TAVI Registry

The study's primary outcome was the incidence of NACEs, including stroke, cardiovascular death, myocardial infarction, and major or life-threatening bleeding. The authors excluded patients who received anticoagulation or had procedural complications. The rest of the patients were divided into three groups based on the antithrombotic regimen at discharge: 1) no antithrombotic therapy, 2) single-antiplatelet therapy, and 3) dual-antiplatelet therapy.

The authors reported the following findings:

3,575 TAVR patients were included (None, 293; SAPT, 1,354; DAPT, 1,928).

After a median follow-up period was 841 days, the incidence of NACEs did not differ between the groups (None vs SAPT: adjusted HR [aHR]: 1.18; None vs DAPT: aHR: 1.09).

There was a lower incidence of all bleeding in patients with no antithrombotics (None vs SAPT: aHR: 0.63; None vs DAPT: aHR: 0.51).

The valve performance was similar among the groups. Leaflet thrombosis was detected in 8.5% of the nonantithrombotic group.

"The nonantithrombotic strategy compared with SAPT/DAPT was not associated with an increased NACEs risk and potentially reduced the risk of bleeding events," the authors wrote. "The nonantithrombotic strategy may be an acceptable substitute to SAPT/DAPT in selected TAVR patients."

In contrast to the current guidelines recommending SAPT post-TAVR, the findings indicate that even lifelong low-dose aspirin and short-term DAPT may not be required after TAVR. The current preference for SAPT after TAVR is based on trials such as POPular TAVI, in which SAPT was linked with a lower incidence of bleeding without an increased ischemic events risk compared with DAPT.

Reference:

The study titled "No Antithrombotic Therapy After Transcatheter Aortic Valve Replacement: Insight From the OCEAN-TAVI Registry" was published in JACC: Cardiovascular Interventions. DOI: 10.1016/j.jcin.2022.10.010