The current standard of care following TAVR is SAPT, which involves the use of only one antiplatelet drug, such as aspirin, to prevent blood clot formation. Traditionally, SAPT is used compared to DAPT, mainly based on the lower bleeding risk; however, the data on mortality are inconclusive. This insight is increasingly important as the number of TAVR procedures performed has steadily increased, making it the most common procedure for patients with aortic stenosis.
Researchers analyzed real-world data from the multicenter TRITAVI registry to determine the differing therapies’ effect on mortality. 5,514 patients (81.5+6.8 years, 48.4% males) were discharged either on SAPT (n=3,197) or DAPT (n=2,317).
The all-cause mortality and rate of major bleeding at six months were significantly lower in the SAPT group as compared with the DAPT group (2.4% vs 5.4%, and 0.5% vs. 1.3%, respectively). SAPT was associated with lower cardiovascular and non-cardiovascular mortality, as compared to DAPT (1.3% vs 2.2% and 1.1% vs 3.2%, respectively). Sensitivity analyses confirmed that DAPT was significantly associated with mortality both in men (adjusted HR: 2.08; 95% CI: 1.32-3.30) and in women (adjusted HR: 1.53; 95% CI: 1.03-2.29), as well as in patients with coronary artery disease (CAD) (adjusted HR: 1.83; 95% CI: 1.01-3.35) and in patients without CAD (adjusted HR: 1.52; 95% CI: 1.04-2.20).
“We were surprised to find that SAPT, rather than DAPT, after TAVR is associated with a better outcome, even in patients with CAD,” said Francesco Pelliccia, MD, PhD, Associate Professor of Cardiology at Sapienza University in Rome, Italy, and lead author of the study. “The results, for the first time, provide clinicians more information on how to treat their patients who are at high risk for bleeding and provide evidence that SAPT should be considered the standard of care in all patients undergoing TAVR.
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