Clin Res Cardiol (2021)
DOI DOI https://doi.org/10.1007/s00392-021-01843-w
Dual versus single antiplatelet therapy prior to transcatheter aortic valve implantation
H. Seoudy1, M. Thomann1, M. Saad1, J. Frank1, T. Pühler2, G. Lutter2, O. J. Müller1, N. Frey3, D. Frank1
1Klinik für Innere Medizin III, Schwerpunkt Kardiologie und Angiologie, Universitätsklinikum Schleswig-Holstein, Kiel; 2Klinik für Herz- und Gefäßchirurgie, Universitätsklinikum Schleswig-Holstein, Kiel; 3Klinik für Innere Med. III, Kardiologie, Angiologie u. Pneumologie, Universitätsklinikum Heidelberg, Heidelberg;
Background
Dual antiplatelet therapy (DAPT) is an established treatment strategy after percutaneous coronary intervention and myocardial infarction. As DAPT may be associated with periprocedural bleeding events cardiac interventions, it may be interrupted and switched to single antiplatelet therapy (SAPT) in certain situations. Transcatheter aortic valve implantation (TAVI) has emerged as the standard of care for patients with severe aortic valve stenosis (AS) who are at high- and intermediate surgical risk. As coronary artery disease and AS share common risk factors, a significant number of AS patients have an appropriate indication for preprocedural DAPT or SAPT. However, the impact of pre-existing DAPT on procedural outcomes compared to SAPT in patients undergoing TAVI has not been well studied.

Methods
We performed an analysis of patients undergoing transfemoral TAVI who were receiving either DAPT or SAPT for appropriate indications prior to the procedure. Patients were grouped into a DAPT and SAPT group, accordingly. Only patients receiving a third-generation TAVI prosthesis were included in our study. The primary outcome was the incidence of bleeding complications as defined by the Valve Academic Research Consortium.


Results
A total of 529 TAVI patients were included in our analysis. Any bleeding complications were observed in 153 patients (=28.9%), while major/life-threatening bleeding events occurred in 60 patients (11.3%). Our study revealed no significant difference between the DAPT vs. SAPT group regarding bleeding complications (neither any nor serious bleeding events). Based on Cox regression modelling, life-threatening/disabling bleeding events were independently associated with long-term mortality after TAVI (HR 8.66, 95% CI 3.31-22.65, p<0.001).

Conclusions
In patients undergoing TAVI who were receiving antiplatelet therapy prior to the procedure, both DAPT and SAPT showed a comparable safety profile regarding procedural bleeding complications.

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