Which is the best anti-aggregant or anti-coagulant therapy after TAVI? A propensity matched analysis from the ITER registry. The management of DAPT after TAVI

AIMS: Safety and efficacy of single vs. dual antiplatelet therapy (DAPT) in patients undergoing TAVI remain to be addressed. METHODS AND RESULTS: All consecutive patients enrolled in the ITER registry were included. Patients undergoing TAVI discharged with aspirin alone were compared to those assuming DAPT before and after selection with propensity score with matching. Subgroup analysis was performed for those on OAT. Prosthetic heart valve dysfunction at follow-up was the primary end point whereas all cause death, cardiovascular death, bleedings, vascular complications and cerebrovascular accidents were the secondary ones. From 1364 patients, after propensity score with matching 605 were selected for each group (aspirin alone vs. DAPT). At 30 days, rates of VARC mortality were lower in patients with aspirin alone (1.5% vs. 4.1%, p 0.003), mainly driven by a reduction of major vascular complications (5.3% vs. 10.7%, p<0.001) and of major bleedings (6.6% vs. 11.5%, p<0.001), without a difference on prosthetic heart valve dysfunction after 45±14 months (2.8% vs. 3.0%, p 0.50). These results were confirmed at multivariable analysis. CONCLUSIONS: After TAVI with self-expandable prosthesis, aspirin alone does not increase risk of prosthetic valve dysfunction, and reduces risk of peri-procedural complications and of 30 days all cause death.