There is wide variation in antithrombotic regimens after valve-in-valve (ViV) TAVR and no significant differences in outcomes, according to a study published July 27 in JACC: Cardiovascular Interventions.

Including 18,414 patients from the STS/ACC TVT Registry, Hiroki A. Ueyama, MD, et al., explored temporal trends, variability and clinical outcomes of antithrombotic strategies used in patients undergoing ViV TAVR between January 2015 and March 2024. Overall, 27% of patients had single antiplatelet therapy (SAPT), 54% had dual antiplatelet therapy (DAPT) and 19% had oral anticoagulation (OAC)-based therapy. Clinical outcomes including all-cause mortality, stroke and bleeding were assessed at one year.

Over the course of the study period, DAPT use declined while SAPT increased and became the predominant strategy by 2024. OAC-based therapy was used the least. There was significant variability in the strategies used by operators and sites. Compared with SAPT, results at one year did not show any differences in outcomes with DAPT or OAC-based therapy, respectively, for the following endpoints: all-cause mortality (adjusted hazard ratio [HR_adj], 0.9 vs. 1.14); stroke (HR_adj, 0.98 vs. 1.09) or bleeding (HR_adj, 0.86 vs. 0.88).

"With practice patterns in flux, it is imperative for a broad readership – including interventionalists, general cardiologists, and primary care physicians who manage antithrombotic regimens daily – to recognize the evolving landscape and substantial variability in practice patterns, and to seek alignment with emerging data and local consensus when guiding therapy," write the authors.

In an accompanying editorial comment, Matthew A. Cavender, MD, MPH, FACC, and Spencer Ng, MD, add that "the appropriate antithrombotic regimen following ViV TAVR will not be known without adequately powered randomized trials. This is exactly the type of question for which a pragmatic clinical trial, potentially even using the TVT Registry as a platform for randomization, would be ideal."