Aspirin with or without Clopidogrel after Transcatheter Aortic-Valve Implantation
Abstract
This randomized controlled trial (POPular TAVI, cohort A) assessed the impact of single versus dual antiplatelet therapy on bleeding and thromboembolic outcomes in patients undergoing transcatheter aortic-valve implantation (TAVI) without long-term anticoagulation indications. 665 patients were assigned to receive either aspirin alone or aspirin plus clopidogrel for three months. Aspirin monotherapy resulted in significantly lower rates of all bleeding (15.1% vs. 26.6%; RR: 0.57; P = 0.001) and non-procedure-related bleeding (15.1% vs. 24.9%; RR: 0.61; P = 0.005). A composite outcome including death from cardiovascular causes, bleeding, stroke, or myocardial infarction favored aspirin alone (23.0% vs. 31.1%; RR: 0.74; P = 0.04). Rates of ischemic events alone (death, stroke, MI) were similar between groups (9.7% vs. 9.9%). The study concludes that aspirin alone reduces bleeding and combined adverse outcomes without increasing thromboembolic risk, challenging current dual therapy recommendations.
Keywords:
transcatheter aortic-valve implantation (TAVI)
aspirin
clopidogrel
antiplatelet therapy
bleeding risk
cardiovascular events
randomized trial
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