Anticoagulation with or without Clopidogrel after Transcatheter Aortic-Valve Implantation

This randomized trial compared oral anticoagulation (OAC) alone versus OAC plus clopidogrel for 3 months in 313 patients undergoing transcatheter aortic-valve implantation (TAVI) with an indication for long-term anticoagulation (95% with atrial fibrillation). At 12 months, OAC alone significantly reduced all bleeding (21.7% vs. 34.6%; RR 0.63, 95% CI 0.43–0.90) and non-procedure-related bleeding (21.7% vs. 34.0%; RR 0.64, 95% CI 0.44–0.92), primarily driven by minor bleeding at the access site. Composite outcomes (cardiovascular death, stroke, or myocardial infarction) showed noninferiority for OAC alone, with no significant difference in ischemic events (13.4% vs. 17.3%). The trial supports OAC monotherapy to reduce bleeding without increasing thromboembolic risk in this population

This randomized trial compared oral anticoagulation (OAC) alone versus OAC plus clopidogrel for 3 months in 313 patients undergoing transcatheter aortic-valve implantation (TAVI) with an indication for long-term anticoagulation (95% with atrial fibrillation). At 12 months, OAC alone significantly reduced all bleeding (21.7% vs. 34.6%; RR 0.63, 95% CI 0.43–0.90) and non-procedure-related bleeding (21.7% vs. 34.0%; RR 0.64, 95% CI 0.44–0.92), primarily driven by minor bleeding at the access site. Composite outcomes (cardiovascular death, stroke, or myocardial infarction) showed noninferiority for OAC alone, with no significant difference in ischemic events (13.4% vs. 17.3%). The trial supports OAC monotherapy to reduce bleeding without increasing thromboembolic risk in this population