Dual Antiplatelet Therapy Versus Aspirin Alone in Patients Undergoing Transcatheter Aortic Valve Implantation

Antithrombotic treatment following transcatheter valve replacement: current considerations

“…In accordance with these results, two recent meta-analyses reported similar cerebrovascular event rates in TAVR patients receiving aspirin versus DAPT (16,17). Overall, SAT-TAVI (12) and Ussia et al (13) trials, presented no significant differences in both 30-day ischemic (mortality, myocardial infarction, stroke) and bleeding events between aspirin monotherapy and DAPT, except the lower rate of cumulative major and minor VASC complications in aspirin versus DAPT treated patients (5% versus 13.3%, P<0.05) in the SAT-TAVI trial.…”

“…Similar to the previous mentioned studies (11)(12)(13), the mortality and thromboembolic event rates demonstrated no difference between single and dual antiplatelet treated groups. In accordance with SAT-TAVI trial, overall vascular complications were significantly reduced in single (11) Durand (14) SAT-TAVI (12) Poliacikova (15) Ussia ( (11) Durand (14) SAT-TAVI (12) Poliacikova (15) Ussia ( , in naive patients aspirin alone (75 mg) was initiated the day before TAVI and followed lifelong.…”

“…Similarly, SAT-TAVI trial (12) randomized 120 patients undergoing TAVR to aspirin versus aspirin and clopidogrel and showed no difference in 30-day major stroke rate (1.7% in both groups). Ussia et al (13) reported a 30-day stroke rate of 5% in aspirin versus 3% in DAPT group, in a total population of 79 patients following TAVR with the CoreValve system. In accordance with these results, two recent meta-analyses reported similar cerebrovascular event rates in TAVR patients receiving aspirin versus DAPT (16,17).…”

“…The rationale of DAPT in TAVI patients consists in the ischemic event prevention, especially stroke, periprocedurally as well as in the first month post the procedure. The ARTE, SAT-TAVI and Ussia et al randomized trials demonstrated the lack of any beneficial impact of DAPT (aspirin and clopidogrel) on the stroke prevention post TAVR (11)(12)(13). Interestingly, ARTE trial (11) randomized 222 patients to aspirin versus aspirin plus clopidogrel following TAVR and revealed no significant difference in the 30-and 90-day stroke rate (0.9% versus 2.7% in aspirin versus DAPT groups), except a general tendency toward a lower incidence of mortality, myocardial infarction and stroke of aspirin alone, as described in Table 3.…”

Evaluation of current practices in transcatheter aortic valve implantation: The WRITTEN (WoRldwIde TAVI ExperieNce) survey

“…The survey showed that this recommendation was followed by the vast majority of centers, but that major differences existed in the duration of antithrombotic therapy. Importantly, data on antithrombotic treatment post-TAVI are limited to observational studies and very small randomized studies (aspirin+clopidogrel) [42]. Several larger randomized studies are currently ongoing [41] and should provide evidence-based data with respect to the optimal antithrombotic therapy strategy.…”