POPular TAVI: Aspirin With or Without Clopidogrel Post-TAVI in Patients Not Taking Oral Anticoagulation?

In patients not taking oral anticoagulation, aspirin alone compared with aspirin plus clopidogrel following transcatheter aortic valve implantation (TAVI) significantly reduced bleeding rates and did not increase thromboembolic events, according to findings from the POPular TAVI trial. The results, presented at ESC Congress 2020 and simultaneously published in the New England Journal of Medicine, challenge current guideline recommendations regarding antiplatelet therapy post-TAVI in this patient population.

While previous findings from POPular TAVI involving a cohort of patients on chronic oral anticoagulation were presented as part of ACC.20/WCC Virtual, the current findings address a cohort of patients not on oral anticoagulation. Investigators randomly allocated 665 patients to aspirin alone (331 patients) or aspirin with three months of clopidogrel (334 patients). The primary outcomes were: 1) all bleeding (procedural and non-procedural) and 2) non-procedural bleeding. Secondary outcomes looked at both bleeding and thromboembolic events, as well as thromboembolic events alone.

Overall, bleeding occurred in 50 patients (15.1%) receiving aspirin alone compared with 83 patients (24.9%) taking aspirin plus clopidogrel at one year. Non-procedural bleeding occurred in 50 patients (15.1%) in the aspirin alone group vs. 83 patients (24.9%) in the aspirin plus clopidogrel group. Researchers also found aspirin alone to be superior to combined therapy in terms of both bleeding and thromboembolic events (23% vs. 31.1%). However, when broken out there was so significant difference in the number of thromboembolic events between the aspirin and aspirin plus clopidogrel groups (9.7% vs. 9.9%, respectively).

"Aspirin alone as compared to aspirin with clopidogrel reduced the bleeding rate significantly, with an absolute reduction of more than 10%," said coordinating investigator Jorn Brouwer, MD, of St. Antonius Hospital, Nieuwegein, the Netherlands.

Keywords: ESC Congress, ESC20, Transcatheter Aortic Valve Replacement, Aspirin, Aortic Valve Stenosis, Angiography, Percutaneous Coronary Intervention

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