Single antiplatelet therapy (SAPT) after transcatheter aortic valve replacement (TAVR) is linked to better cardiovascular outcomes than dual antiplatelet therapy (DAPT), according to a new meta-analysis published in Current Problems in Cardiology.[1] The heightened risk of bleeding associated with DAPT was the primary difference between the two treatment options.
“With broadening indications for TAVR, optimal medical management of patients post-TAVR is crucial to establish favorable outcomes,” wrote lead author Gauranga Mahalwar, MD, a specialist with the department of internal medicine at Cleveland Clinic, and colleagues. “The cornerstone of medical management post TAVR is to maintain adequate antithrombotic activity in order to avoid leaflet thrombosis and other thrombotic complications, whilst balancing the risk of bleeding.”
The group reviewed data from 152 different studies published from 2005 to 2022, including six randomized controlled trials (RCTs) in its final analysis. The primary outcome was stroke, but bleeding events, myocardial infarction, all-cause mortality and cardiac mortality were all secondary outcomes. All patients included in the analysis had no prior indication for anticoagulation therapy.
Overall, Mahalwar et al. found that SAPT and DAPT were associated with comparable clinical outcomes when it came to most outcomes. The one exception was major/life-threatening bleeding events, which were much less common when patients are prescribed SAPT after TAVR.
“Patients who most frequently receive TAVR are elderly, who are also at an increased risk of bleeding complications, and hence it is crucial to provide only the needed/required level of anticoagulation,” the authors wrote.
The researchers did note that their meta-analysis had certain limitations. They did not track the type of valve used for each procedure, for instance, or whether it was a balloon-expandable valve or self-expanding valve.
“The present analysis found SAPT to be the preferred antithrombotic regimen in patients post TAVR compared with other regimens, mainly as a result of lower bleeding risk,” Mahalwar and colleagues concluded.
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