A safer bet for MitraClip: Choosing between single antiplatelet therapy and dual antiplatelet therapy

Optimal antithrombotic therapy after mitral valve transcatheter edge-to-edge repair (TEER) remains uncertain.

To compare the efficacy and safety of single antiplatelet therapy (SAPT) versus dual antiplatelet therapy (DAPT) in mitral TEER recipients.

We retrospectively queried the TriNetX Global Network, identifying 3325 adult patients who underwent mitral TEER, excluding those with recent coronary or aortic interventions and prior major bleeding or stroke. After propensity score matching, 900 patients each received SAPT or DAPT. Primary outcomes were ischemic stroke and gastrointestinal (GI) bleeding at 30, 90, 180 days, and one year.

Stroke incidence was similar at every interval; at one year, it was 2.7 % with SAPT versus 2.3 % with DAPT (HR 1.15, 95 % CI 0.64-2.06; p = 0.91). GI bleeding risk, although trending lower with SAPT, likewise showed no significant difference, occurring in 3.6 % versus 4.0 % of patients at one year (HR 0.89, 95 % CI 0.55-1.43; p = 0.97). Supplementary analyses comparing clopidogrel or aspirin monotherapy with DAPT yielded similar neutral findings.

In this propensity-matched cohort, SAPT offered thromboembolic protection equivalent to DAPT through one year after mitral TEER without increasing GI bleeding risk. These data support de-escalating to SAPT after the early post-procedural phase.