Antithrombotic Therapy Selection and Association With Clinical Outcomes Following Valve-in-Valve Transcatheter Aortic...

Valve-in-valve (ViV) transcatheter aortic valve replacement (TAVR) is being performed frequently for patients with bioprosthetic aortic valve (AV) degeneration. There is little guidance on appropriate antithrombotic selection after ViV TAVR. We aimed to analyze the impact of different antithrombotic strategies on AV hemodynamics and clinical outcomes following ViV TAVR.

Consecutive patients who underwent ViV TAVR at our center from January 1, 2019, to June 30, 2023, were included. Patients were divided into antiplatelet plus anticoagulant (AP + AC) or antiplatelet (AP) only groups based on the therapies prescribed on discharge. AV hemodynamics at discharge, 1 month, and 1 year, along with 1-year clinical outcomes, were compared between AP + AC and AP groups.

This study included 104 patients with 74 patients (71.2%) in the AP + AC group and 30 patients (28.8%) in the AP group. Atrial fibrillation history (p = 0.003) was associated with AP + AC whereas GI bleeding history (p = 0.01) was associated with AP alone. There was no significant difference in antithrombotic therapy selection by TAVR type, but patients without a pre-existing indication for AC were more often discharged on AP + AC after receiving smaller diameter Sapien valves (p = 0.036). Additionally, patients were discharged on AP + AC more often if they required leaflet modification during TAVR (p = 0.043). There were no significant differences in AV gradients or clinical outcomes between antithrombotic strategies throughout follow-up.

Anticoagulation was used more often than AP alone following ViV TAVR, but there were no significant differences in AV hemodynamics by echocardiography or clinical outcomes between antithrombotic groups through 1 year of follow-up.