When compared with single antiplatelet therapy (SAPT), dual antiplatelet therapy (DAPT) after valve-in-valve TAVI to treat surgical bioprosthesis dysfunction may be associated with a lower one-year stroke incidence, according to a study presented at the 46th National Congress GISE 2025 and simultaneously published Oct. 3 in JACC: Cardiovascular Interventions. No significant difference was observed for bleeding outcomes, premature valve deterioration or other major ischemic events between the two groups.
A total of 278 patients treated with valve-in-valve TAVI at 10 participating centers between January 2008 and July 2023 were included in this retrospective, observational study. Francesco Benandi, MD, et al., grouped participants according to treatment with SAPT or DAPT. Patients treated with oral anticoagulant therapy were excluded. Of the included participants, 113 were treated with SAPT and 165 with DAPT. Of note, patients in the DAPT group were older, had a higher prevalence of hypertension and obstructive coronary artery disease, as well as a higher surgical risk according to the Society of Thoracic Surgeons score.
The primary efficacy outcome was major adverse cardiac and cerebrovascular events (MACCE), a composite of cardiovascular death, stroke and myocardial infarction, and the primary safety outcome was major bleeding. Clopidogrel was used in 99% of patients treated with DAPT, and aspirin was used in 95% of patients treated with SAPT.
At one-year follow-up, both clinical and echocardiographic outcomes were analyzed, and no difference between the two groups was observed for MACCE (hazard ratio [HR], 0.499; p=0.187), major bleedings (HR, 0.776; p=0.741) and death (HR, 0.907; p=0.874). There was also no significant difference in moderate or severe structural valve deterioration. However, patients treated with DAPT suffered fewer strokes (HR, 0.093; p=0.033). Additionally, minor bleeding was more frequent in patients treated with DAPT.
“Future studies with larger populations are needed to confirm these findings, particularly the potential protective effect of dual antiplatelet therapy on stroke incidence and premature valve degeneration,” write the authors.