Aspirin Versus Aspirin Plus Clopidogrel as Antithrombotic Treatment Following Transcatheter Aortic Valve Replacement With a Balloon-Expandable Valve

Abstract

This small trial showed that SAPT (vs. DAPT) tended to reduce the occurrence of major adverse events following TAVR. SAPT reduced the risk for major or life-threatening events while not increasing the risk for MI or stroke. Larger studies are needed to confirm these results. (Aspirin Versus Aspirin + Clopidogrel Following Transcatheter Aortic Valve Implantation: The ARTE Trial [ARTE], NCT01559298; Aspirin Versus Aspirin+Clopidogrel as Antithrombotic Treatment Following TAVI [ARTE], NCT02640794).

Antithrombotic treatment following transcatheter valve replacement: current considerations

“…Similar to the previous mentioned studies (11)(12)(13), the mortality and thromboembolic event rates demonstrated no difference between single and dual antiplatelet treated groups. In accordance with SAT-TAVI trial, overall vascular complications were significantly reduced in single (11) Durand (14) SAT-TAVI (12) Poliacikova (15) Ussia ( (11) Durand (14) SAT-TAVI (12) Poliacikova (15) Ussia ( , in naive patients aspirin alone (75 mg) was initiated the day before TAVI and followed lifelong.…”

“…The rationale of DAPT in TAVI patients consists in the ischemic event prevention, especially stroke, periprocedurally as well as in the first month post the procedure. The ARTE, SAT-TAVI and Ussia et al randomized trials demonstrated the lack of any beneficial impact of DAPT (aspirin and clopidogrel) on the stroke prevention post TAVR (11)(12)(13). Interestingly, ARTE trial (11) randomized 222 patients to aspirin versus aspirin plus clopidogrel following TAVR and revealed no significant difference in the 30-and 90-day stroke rate (0.9% versus 2.7% in aspirin versus DAPT groups), except a general tendency toward a lower incidence of mortality, myocardial infarction and stroke of aspirin alone, as described in Table 3.…”

“…In patients previously treated with clopidogrel, clopidogrel was continued during TAVI without either additional loading dose before TAVI or aspirin administration; * (11). Indeed, ARTE trial confirmed that DAPT is correlated with an increased rate risk of severe bleeding [major or life threatening compared to patients receiving aspirin (11)].…”

“…In patients previously treated with clopidogrel, clopidogrel was continued during TAVI without either additional loading dose before TAVI or aspirin administration; * (11). Indeed, ARTE trial confirmed that DAPT is correlated with an increased rate risk of severe bleeding [major or life threatening compared to patients receiving aspirin (11)]. Notably, the majority of bleeding events in DAPT treated patients were correlated with vascular access site complications, whereas a great number of non-access related bleedings such as gastrointestinal bleeding recorded in these patients.…”

“…On the other hand, no beneficial impact of DAPT over single antiplatelet therapy regarding cerebrovascular event prevention has been proven by several TAVR studies (23)(24)(25)(26). It is well known that 50% of strokes within the first month post TAVR occur periprocedurally or within 24 hours post procedure, whereas the stroke risk seems to peak within the first 7 days post TAVR (11). Acute strokes stem from embolic events during the mechanical interaction of the transcatheter valve system with the highly calcified native aortic valve, while subacute strokes can be induced by more traditional predisposing factors such as atrial fibrillation.…”