Short-term dual anti-platelet therapy decreases long-term cardiovascular mortality after transcatheter aortic valve...

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Clinical Trials

Background:

• Limited data exist on the optimal duration of dual anti-platelet therapy (DAPT) beyond one year following transcatheter aortic valve replacement (TAVR).
• The long-term prognostic impact of continuing or discontinuing DAPT after the initial post-TAVR period remains unclear.

Purpose of the Study:

• To evaluate the effect of discontinuing DAPT within one year on adverse events occurring later than one year after TAVR.
• To compare cardiovascular death, bleeding events, and ischemic stroke rates between patients continuing DAPT and those switching to single anti-platelet therapy (SAPT).

Main Methods:

• Analysis of 1008 patients from the OCEAN-TAVI registry who survived the first year post-TAVR on DAPT.
• Patients were categorized into a 'DAPT group' (continued DAPT at 1 year) and a 'stop-DAPT group' (switched to SAPT at 1 year).
• Comparison of long-term outcomes (cardiovascular death, bleeding, stroke) using statistical analyses including Cox regression and propensity score weighting.

Main Results:

• The 'stop-DAPT' group showed a significantly lower incidence of cardiovascular death after one year compared to the 'DAPT' group (1.8% vs. 4.9%, P=0.029).
• Discontinuing DAPT was associated with reduced cardiovascular death in Cox regression (aHR, 0.46; 95% CI, 0.20-0.99) and propensity score-weighted analyses (aHR, 0.45; 95% CI, 0.20-0.98).

Conclusions:

• Switching from DAPT to SAPT within one year after TAVR is associated with a significantly lower risk of cardiovascular death beyond the first year.
• These findings suggest that a de-escalation of anti-platelet therapy may be a safe and beneficial strategy in select TAVR patients.