Single antiplatelet therapy (SAPT) after transcatheter aortic valve implantation (TAVI) is associated with a significantly lower incidence of six-month mortality and major bleeding risk compared to dual antiplatelet therapy (DAPT).
This is the finding of the Transfusion requirements in transcatheter aortic valve implantation—TRITAVI—registry, presented during a late-breaking trial session by Francesco Pelliccia (Sapienza University, Rome, Italy) at the Society for Cardiovascular Angiography & Interventions (SCAI) 2025 scientific sessions (1 – 3 May, Washington, DC, USA).
Researchers analysed real-world data from the multicentre TRITAVI registry to determine the differing therapies’ effect on mortality. The analysis included data from 5,514 patients (81.5+6.8 years, 48.4% males) who were discharged either on SAPT (n=3,197) or DAPT (n=2,317).
Pelliccia reported that the all-cause mortality and rate of major bleeding at six months were significantly lower in the SAPT group as compared with the DAPT group (2.4% vs 5.4%, and 0.5% vs. 1.3%, respectively). SAPT was associated with lower cardiovascular and non-cardiovascular mortality, as compared to DAPT (1.3% vs 2.2% and 1.1% vs 3.2%, respectively).
Sensitivity analyses confirmed that DAPT was significantly associated with mortality both in men (adjusted HR: 2.08; 95% CI: 1.32-3.30) and in women (adjusted HR: 1.53; 95% CI: 1.03-2.29), as well as in patients with coronary artery disease (CAD) (adjusted HR: 1.83; 95% CI: 1.01-3.35) and in patients without CAD (adjusted HR: 1.52; 95% CI: 1.04-2.20).
“We were surprised to find that SAPT, rather than DAPT, after TAVI is associated with a better outcome, even in patients with CAD,” said Pelliccia, lead author of the study. “The results, for the first time, provide clinicians more information on how to treat their patients who are at high risk for bleeding and provide evidence that SAPT should be considered the standard of care in all patients undergoing TAVI.”
