Aspirin alone was more successful in reducing the occurrence of major adverse events following transcatheter aortic valve replacement (TAVR) compared with aspirin with clopidogrel, according to research published May 17 in JACC: Cardiovascular Interventions and presented at EuroPCR in Paris.

Josep Rodes-Cabau, MD, et al., examined 222 TAVR candidates, with half randomized to receive dual antiplatelet therapy (DAPT) and half to aspirin alone. There were no differences between groups in baseline and procedural characteristics.

At three-month follow-up, the incidence of death, myocardial infarction (MI), ischemic stroke/transient ischemic attack or major bleeding events tended to be higher in the DAPT group (15.3 vs. 7.2 percent, p=0.065). Aspirin alone decreased the risk of major or life-threatening bleeding post-TAVR while not increasing the risk of MI or stroke. All MI and stroke events occurred during the first 30 days following TAVR. All bleeding events also occurred within the first 30 days after TAVR, and most (56 percent) were related to vascular or access site complications. Clopidogrel was stopped temporarily or definitely in 21 DAPT patients because of adverse events.

As this was a small, open-label trial, the authors caution that these results should be interpreted as hypothesis-generating and should serve to design a definitive trial for determining the optimal antithrombotic treatment in TAVR candidates.

In a related editorial comment, Davide Capodanno, MD, and Dominick J. Angiolillo, MD, PhD, FACC, add that "Because life-threatening or disabling bleeding remains a substantial cause of morbidity in elderly patients who are currently offered TAVR, further investigations of strategies that positively affect the efficacy-safety trade-off of antithrombotic therapy are needed in this fragile population."

Keywords: Angiography, Aspirin, Follow-Up Studies, Hemorrhage, Incidence, Ischemic Attack, Transient, Myocardial Infarction, Stroke, Ticlopidine, Transcatheter Aortic Valve Replacement, Deoxyadenosines

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