Dual Antiplatelet Therapy Offers No Outcome Benefit After Valve-in-Valve TAVI: Study

A new study published in the journal of JACC Cardiovascular intervention showed that although there was no discernible difference in other major ischemic and bleeding events or early valve degeneration, dual antiplatelet treatment (DAPT) following valve-in-valve transcatheter aortic valve intervention (TAVI) may be linked to a decreased one-year incidence of stroke.

As a less intrusive option to repeated surgical valve replacement, TAVI has become the treatment of choice for patients experiencing bioprosthetic valve failure. Although it has been widely used to prevent thromboembolic events, dual antiplatelet treatment, which usually combines aspirin and clopidogrel, involves a higher risk of bleeding problems.

On the other hand, single antiplatelet treatment (SAPT) could provide a safer profile without sacrificing its ability to prevent ischemic events or valve thrombosis. The usual use of DAPT after TAVI has been called into doubt by recent research, especially in patients with comorbidities or increased bleeding risk. Comparing the results of patients treated with SAPT or dual antiplatelet treatment in the first year following valve-in-valve TAVI was the goal of this study.

Patients who received treatment with oral anticoagulant medication were excluded, whereas those who had valve-in-valve TAVI at 10 participating facilities were included and categorized according on whether they were receiving DAPT or SAPT. At the one-year follow-up, the clinical and echocardiographic results were examined. After creating a propensity score, hazard ratios (HR) were estimated using inverse probability of treatment weighting to take confounders into consideration.

There were 278 patients in all. significant adverse cardiac and cerebrovascular events (HR 0.499, 95% CI 0.182-1.371, P=0.178), significant bleedings (HR 0.776, 95% CI 0.172-3.504, P=0.741), and mortality (HR 0.907, 95% CI 0.272-3.022, P=0.874) did not vary across groups. The patients receiving DAPT experienced fewer strokes (HR 0.093, 95% CI 0.010-0.831, P=0.033). Furthermore, no discernible difference was seen between moderate and severe structural valve degeneration (1.9% vs. 6.0%, P=0.161).

Overall, the increased thrombotic risk linked to reintervention for bioprosthetic valve failure has sparked interest in dual antiplatelet treatment following valve-in-valve transcatheter aortic valve intervention (TAVI). However, in this retrospective study, DAPT did not improve outcomes compared with single antiplatelet therapy.

Source:

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