Dual as safe as single antiplatelet therapy during TAVR

Surgical safety outcomes are comparable between existing dual (DAPT) and single (SAPT) antiplatelet therapy in patients undergoing transcatheter aortic valve replacement (TAVR), a recent study has found.

The study included 529 patients (median age 81.7 years, 55.6 percent women) undergoing transfemoral TAVR, of whom 167 were on DAPT while 362 were receiving SAPT prior to the procedure. In compliance with guidelines, SAPT patients were switched to DAPT for 90 days after the surgery. The primary endpoint was the incidence of bleeding events at 30 days, as assessed by the Valve Academic Research Consortium-2 (VARC-2) system.

VARC-2 all (29.9 percent vs 28.5 percent; p=0.726), minor (19.8 percent vs 16.6 percent; p=0.371), major (6.6 percent vs 6.1 percent; p=0.822), and life-threatening or disabling (3.6 percent vs 5.8 percent; p=0.395) bleeding events at 30 days did not differ between DAPT and SAPT groups.

The same remained true when considering individual types of bleeding events and ischaemic complications at 30 days. This includes access-site bleeding (DAPT vs SAPT: 24.6 percent vs 19.6 percent, respectively; p=0.196), as well as pericardial bleeding (1.8 percent vs 5.0 percent; p=0.096) and chronic anaemia (4.2 percent vs 3.3 percent; p=0.620), among others.

Post-procedural outcomes were comparable, too, with 90-day mortality rates of 3.6 percent and 6.1 percent in the DAPT and SAPT groups, respectively (p=0.298).

“In patients undergoing TAVR who were receiving antiplatelet therapy prior to the procedure, both DAPT and SAPT showed a comparable safety profile regarding periprocedural bleeding complications. If DAPT is indicated, we advocate its uninterrupted continuation in patients undergoing TAVR,” the researchers said.