Key takeaways:
- Single antiplatelet remedy was tied to decrease 6-month mortality threat vs. twin antiplatelet remedy after transcatheter aortic valve alternative.
- The outcomes had been constant by intercourse and presence of CAD.
In a registry of sufferers who underwent transcatheter aortic valve alternative, those that had single antiplatelet remedy after their process had diminished threat for mortality at 6 months in contrast with twin antiplatelet remedy.
Francesco Pelliccia, MD, PhD, affiliate professor of cardiology at Sapienza College in Rome, and colleagues analyzed information from 5,514 sufferers from the TRITAVI registry who underwent TAVR with femoral entry at one in every of 20 European facilities since 2012, who had been discharged alive after their process, who weren’t on anticoagulation remedy, who didn’t have procedural problems and who didn’t have ACS or PCI inside 1 yr earlier than the process.
“Guideline suggestions state that we should always use single antiplatelet therapy except there is a sign to anticoagulation,” Pelliccia stated throughout a press convention on the Society for Cardiovascular Angiography and Interventions Scientific Classes. “However in actual life, this alternative is commonly not executed by the physicians.”
‘There’s a reluctance’
Pelliccia instructed Healio that the rule suggestions, significantly in the USA, usually are not sturdy, “they usually inform our cardiologists to be at liberty to go for the most effective remedy to your affected person. DAPT was the usual of care in 2010, when TAVR began all through the world, and it stays that means in the actual world, regardless of rising proof popping out from randomized managed trials. There’s a reluctance to prescribe single antiplatelet remedy [due to] worry that [it does] not scale back thrombotic threat sufficient.”
Among the many cohort, 3,197 sufferers had single antiplatelet remedy (SAPT), most frequently aspirin monotherapy, after their process and a pair of,317 had DAPT, most frequently aspirin plus clopidogrel, he stated.
At 6 months, the DAPT group had elevated threat for all-cause mortality in contrast with the SAPT group (adjusted HR = 1.65; 95% CI, 1.22-2.23; P = .007; log-rank P < .0001), Pelliccia stated in the course of the press convention.
“We didn’t anticipate such an enormous distinction in 6 months,” Pelliccia instructed Healio. “We now have information for a subset of sufferers as much as 3 years, and we anticipated a distinction in longer follow-up.”
Main bleeding was decrease within the SAPT group (0.5% vs. 1.3%; P = .001) and ischemic occasions trended decrease within the SAPT group (0.4% vs. 0.7%; P = .047), he stated.
“Bleeding performed a serious function [in the mortality results], however it isn’t the one clarification,” Pelliccia instructed Healio. “[DAPT] was chosen in sufferers who had been judged to be at increased thrombotic threat as a result of that they had a number of comorbidities, as an example, peripheral artery illness and continual obstructive pulmonary illness. This was a giant mistake. These sufferers are extra frail, so they may undergo extra from stronger antithrombotic therapy.”
He stated the mortality outcomes didn’t differ by intercourse (aHR for DAPT vs. SAPT for males = 2.08; 95% CI, 1.32-3.3; P = .001; log-rank P < .001; aHR for girls = 1.53; 95% CI, 1.03-2.29; P = .04) or by presence of CAD (aHR for CAD = 1.83; 95% CI, 1.01-3.35; P = .04; log-rank P < .004; aHR for no CAD = 1.52; 95% CI, 1.04-2.2; P = .03; log-rank P = .005).
The CAD findings had been “positively sudden,” Pelliccia instructed Healio.
“We consider these findings are crucial,” Pelliccia stated in the course of the press convention. “This is without doubt one of the first demonstrations in real-life scientific observe that single antiplatelet therapy is related not solely with a lower within the frequency of bleeds but additionally with … decrease 6-month mortality after the process.”
Whereas “one registry can’t make the distinction, we will immediate different investigators to have a look at mortality from antithrombotic therapy,” Pelliccia instructed Healio. “A number of different teams worldwide are wanting on the impact on mortality.”
Sooner or later, he stated, work must be executed on figuring out the optimum single antiplatelet technique, as traditionally, clopidogrel has had a greater security profile than aspirin.
‘I’m going to alter what I do’
In a dialogue on the press convention, David A. Cox, MD, MSCAI, interventional heart specialist at Sanger Coronary heart & Vascular Institute in Charlotte, North Carolina, and previous president of SCAI, stated: “What’s very spectacular about this information is that it modifications observe. For nearly the whole lot, there may be profit to [SAPT], whereas in all these years, sufferers have gotten DAPT, and these are aged sufferers who’re going to bleed extra should you put them on DAPT. Once I take this residence, I’m going to alter what I do.”
For extra info:
Francesco Pelliccia, MD, PhD, might be reached at f.pelliccia@mclink.it.
Sources/Disclosures
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Pelliccia F, et al. Featured scientific analysis. Introduced at: Society for Cardiovascular Angiography and Interventions Scientific Classes; Might 1-3, 2025; Washington, D.C.
Disclosures:
Cox and Pelliccia report no related monetary disclosures.
