TAVR patients who are discharged with dual antiplatelet therapy (DAPT) may have a significantly higher risk of major bleeding events, vs. patients who are discharged with antiplatelet monotherapy, according to a study published July 9 in the American Heart Journal. 

Matthew W. Sherwood, MD, MHS, FACC, et al., used data from the ACC/STS TVT Registry to analyze 16,694 patients who underwent TAVR at 444 hospitals between 2011 and 2016. They sought to describe antiplatelet prescribing patterns without an indication for oral anticoagulation at hospital discharge and determine the relationship between antiplatelet therapy and clinical outcomes one year after TAVR.

According to the results, 81.1 percent of patients (13,546) were discharged on DAPT (aspirin and a P2Y12 inhibitor). The remaining 18.9 percent of patients (3,148) were discharged with either aspirin or a P2Y12 inhibitor. There was significant hospital-level variation in DAPT prescriptions at discharge, with teaching hospitals more likely than nonteaching hospitals to prescript DAPT (70.5 percent vs. 47.6 percent). Among all study participants, 11 percent had died within one year of undergoing TAVR. After adjusting for clinical characteristics, rates of death, stroke and MI at one year were similar between patients on DAPT and those on monotherapy. However, patients on DAPT had a significantly higher risk of major bleeding events.

The researchers conclude that the variability in treatment patterns and clinical outcomes warrants additional research to determine the optimal antiplatelet strategy following TAVR.

Keywords: National Cardiovascular Data Registries, STS/ACC TVT Registry, Heart Valve Diseases, Transcatheter Aortic Valve Replacement

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