Antiplatelet Therapy and All-Cause Mortality After Transcatheter Aortic Valve Replacement: The TRITAVI Registry

Current guidelines recommend single antiplatelet therapy (SAPT) after transcatheter aortic valve replacement (TAVR) in patients without an indication for anticoagulation. This recommendation is mainly based on a better risk profile in terms of bleeding over dual antiplatelet therapy (DAPT), although data on mortality are inconclusive.

We analyzed 6-month and 24-month mortality associated with SAPT and DAPT after femoral TAVR from the Transfusion Requirements in Transcatheter Aortic Valve Implantation registry.

The Transfusion Requirements in Transcatheter Aortic Valve Implantation is a multicenter registry including 10,071 patients undergoing TAVR. For the purpose of the present study, 4,557 patients with indication to anticoagulation, nonfemoral access, recent percutaneous coronary intervention, and procedural complications were excluded. The remaining 5,514 patients (age 81 ± 7 years, 51% males) were discharged either on SAPT (n = 3,197) or DAPT (n = 2,317).

The SAPT group, compared with the DAPT group, experienced lower 6-month all-cause mortality (2.4% vs 5.4%; log-rank P < 0.0001) and major bleeding (0.5% vs 1.3%; log-rank P = 0.001). SAPT was associated with reduced both cardiovascular (1.3%) and noncardiovascular mortality (1.1%), as compared to DAPT (2.2%, P = 0.008 and 3.2%, P = 0.0001, respectively). At 24-month follow-up, overall mortality remained significantly lower with SAPT vs DAPT (11.7% vs 14.2%; log-rank P = 0.007). Cox regression hazard model confirmed the association of DAPT with 6-month (adjusted HR: 1.69; 95% CI: 1.20-2.37; P = 0.002) and 24-month (adjusted HR: 1.21; 95% 1.01-1.46; P = 0.04) all-cause mortality.

In a large real-world population of all comers undergoing TAVR, SAPT was associated with a significantly lower 6-month and 24-month all-cause mortality as compared with DAPT. (Transfusion Requirements in Transcatheter Aortic Valve Implantation [TRITAVI] Study; NCT03740425).