Skip the clopidogrel? TAVR patients benefit from antiplatelet therapy that includes aspirin only
Single antiplatelet therapy (SAPT) is recommended over dual antiplatelet therapy (DAPT) for transcatheter aortic valve replacement (TAVR) patients with no indications for anticoagulation, according to a new study published in the American Journal of Cardiology.
“Current practice guidelines recommend dual antiplatelet therapy with aspirin and clopidogrel for three to six months followed by lifelong aspirin after transcatheter aortic valve implantation,” wrote Agam Bansal, MD, of the Cleveland Clinic’s Heart and Vascular Institute, and colleagues. “However, recently published POPular TAVI trial and other trials that have compared DAPT with SAPT have shown decreased bleeding events and non-inferiority with respect to ischemic stroke, all-cause mortality, and myocardial infarction amongst patients receiving SAPT.”
To learn more about this issue, the team assessed four randomized control trials evaluating the two treatment options. Together, the trials included more than 1,000 TAVR patients. The average follow-up period was 5.5 months.
Overall, DAPT with aspirin and clopidogrel was linked with a much higher risk of a major bleeding or life-threatening bleeding event than SAPT with just aspirin. The risk of stroke, all-cause mortality or myocardial infarction, on the other hand, was so close that there was “no statistical difference.”
When reviewing all data from the four trials, the authors determined that SAPT was linked with a net clinical benefit of 11.27%. The advantage of SAPT, they concluded, was “offered mainly by reduced major or life threatening bleeding rates in the [SAPT] group.”
The full study is available here.
Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.