Aspirin Versus Clopidogrel as Single Antiplatelet Therapy After TAVI: A Propensity Score-Matched, Retrospective...

Current guidelines recommend single antiplatelet therapy (SAPT) with aspirin for most patients undergoing transcatheter aortic valve implantation (TAVI). However, the optimal choice of SAPT, namely aspirin or clopidogrel, remains uncertain. Our study aims to compare the impact of aspirin versus clopidogrel monotherapy on all-cause mortality in patients after TAVI.

Consecutive patients undergoing TAVI treated with single antiplatelet treatment (aspirin or clopidogrel) at two tertiary hospitals between 2012 and 2024 were studied. The primary endpoint was long-term survival over a median follow-up of 49.2 months. Propensity score matching was performed to adjust for baseline differences.

Among 982 patients who underwent transcatheter aortic valve implantation and were treated with single antiplatelet therapy, 730 received aspirin, and 252 received clopidogrel. Patients treated with clopidogrel more frequently had a history of ischemic stroke and prior percutaneous coronary intervention and had lower preprocedural peak transvalvular velocity. Overall survival did not differ significantly between patients treated with aspirin and those with clopidogrel (101.0 months [52.7-149.3] versus 88.3 [49.3-127.3], P = 0.390). After propensity score matching, 141 pairs were identified, and long-term survival remained similar between the two groups (108.7 months [54.6-156.8] versus 88.3 [48.5-117.6], P = 0.204).

To the best of our knowledge, this is the largest study comparing aspirin versus clopidogrel following TAVI. Our analysis showed comparable long-term survival in patients treated with either aspirin or clopidogrel. Further randomized trials are required for the validation of our results.