Abstract 15513: Comparison of Two Antiplatelet Therapy Strategies in Patients Undergoing Transcatheter Aortic Valve Replacement: Is Dual Antiplatelelet Therapy Mandatory?
Background: Dual antiplatelet therapy is commonly used in patients undergoing TAVR but the optimal antiplatelet regimen is uncertain and remains to be determined. We therefore aimed to prospectively compare two strategies of antiplatelet therapy in patients undergoing transcatheter aortic valve replacement (TAVR).
Methods: A strategy using mono antiplatelet therapy (group A, n=164) was prospectively compared to a strategy using dual antiplatelet therapy (group B, n=128) in 292 consecutive patients undergoing TAVR. The primary end point was a combination of mortality, major stroke, life-threatening bleeding (LTB), myocardial infarction, and major vascular complication at 30 days. All adverse events were adjudicated according to the Valve Academic Research Consortium.
Results: The primary end-point occurred in 22 patients (13.4%) in the group A and in 30 patients (23.4%) in the group B (HR 0.51; 95% CI 0.28-0.94, p=0.026). LTB (3.7% vs. 12.5%, p=0.005) and major (2.4% vs. 13.3% p<0.0001) bleedings occurred less frequently in the group A whereas the incidence of stroke (1.2% vs. 4.7%, p=0.14) and myocardial infarction (1.2% vs. 0.8%, p=1.0) was not significantly different between the two groups. The benefit of a strategy using mono versus dual antiplatelet therapy persisted after multivariate adjustment and propensity score-analysis (HR 0.53; 95% CI 0.28-0.95; p=0.033).
Conclusions: A strategy using mono versus dual antiplatelet therapy in patients undergoing TAVR reduces LTB and major bleedings without increasing the risk of stroke and myocardial infarction. The results of our study question the justification of dual antiplatelet therapy, and require confirmation in a randomized trial.
- © 2013 by American Heart Association, Inc.