Dual Versus Single Antiplatelet Therapy After Transcatheter Aortic Valve Implantation for Bioprosthetic Valve Failure

https://www.jacc.org/doi/10.1016/j.jcin.2025.09.018

ABSTRACT

Background: Single antiplatelet therapy (SAPT) is the standard treatment after transcatheter aortic valve intervention (TAVI). However, valve-in-valve transcatheter aortic valve intervention to treat surgical bioprosthesis dysfunction carries an increased thrombotic risk and may benefit from more intensive antithrombotic treatment.

 Objectives: The aim of this study is to compare the outcomes of patients treated with dual antiplatelet therapy (DAPT) or Single antiplatelet therapy in the first year after valve-in-valve transcatheter aortic valve intervention.

 Methods: Patients treated with valve-in-valve transcatheter aortic valve intervention at 10 participating centers were included and grouped according to treatment with dual antiplatelet therapy or Single antiplatelet therapy, while those treated with oral anticoagulant therapy were excluded.Both clinical and echocardiographic outcomes were analyzed at one-year follow up. A propensity score was developed, then inverse probability of treatment weighting was applied in hazard ratios (HR) estimation, to account for confounders.

 Results: A total of 278 patients were included. No differencebetween groups was observed for major adverse cardiac and cerebrovascular events (HR 0.499, 95% confidence interval [CI] 0.182-1.371, P=0.178), major bleedings (HR 0.776, 95% CI 0.172-3.504, P=0.741) and death (HR 0.907, 95% CI 0.272-3.022, P=0.874). Less strokes were observed in patients treated with dual antiplatelet therapy (HR 0.093, 95% CI 0.010-0.831, P=0.033). Additionally, there was no significant difference in moderate or severe structural valve deterioration (1.9% vs 6.0%, P=0.161).

 Conclusions:Dual antiplatelet therapy after valve-in-valve transcatheter aortic valve intervention may be associated with a lower one-year incidence of stroke, while no significant difference was observed for other major ischemic and bleeding outcomes or for premature valve deterioration.

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