SAPT after TAVR linked to key benefits over DAPT, new data confirm
Single antiplatelet therapy (SAPT) after transcatheter aortic valve replacement (TAVR) is associated with a much higher survival rate than dual antiplatelet therapy (DAPT), according to new registry data published in JACC: Advances.[1]
Researchers tracked more than 5,000 patients who underwent TAVR in Italy, Spain, Poland, Finland or England from 2011 to 2023. The mean age was 81 years old, 51% of patients were men and each patient presented without an indication for anticoagulation. All data came from the TRITAVI registry.
While 58% of patients were discharged on SAPT (either aspirin or clopidogrel), the other 42% were discharged on DAPT (aspirin and clopidogrel). Patients sent home on DAPT were more likely to be women or present with cardiovascular risk factors such as hypertension or a history of smoking.
Overall, SAPT was associated with a significantly lower risk of all-cause mortality after six months (2.4% vs. 5.4%) and again after 24 months (11.7% vs. 14.2%). Major bleeding events were also less common among SAPT patients after six months.
Meanwhile, the risk of ischemic events, including stroke, was not different between the two treatment groups.
These trends were consistent across sexes, the authors added, and the valve type—self-expanding “or balloon-expandable—did not significantly impact a patient’s six-month mortality risk.
“Our findings confirm and extend previous knowledge showing for the first time in a real-world, all-comers TAVR population that SAPT is associated with a significantly lower incidence of all-cause mortality at six and 24 months compared with DAPT,” wrote first author Francesco Pelliccia MD, PhD, an interventional cardiologist with Sapienza University of Rome, and colleagues. “These novel data reinforce current recommendations supporting the use of SAPT as an effective strategy not only to reduce bleeding but also to improve survival.”
Another key takeaway was the fact that DAPT became less and less common over time. While 48% of patients were discharged on DAPT after TAVR at the start of the study, that dropped to 38% by the study’s end.
“Our findings revealed a progressive decline in the use of DAPT after TAVR, suggesting that antithrombotic treatment strategies have evolved over time according to emerging scientific evidence and updated clinical practice guidelines,” the authors wrote.
Click here to read the full study in JACC: Advances, an American College of Cardiology journal.
Michael has more than 19 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.