Transcatheter aortic-valve implantation (TAVI) refers to the replacement of the aortic valve of the heart through the blood vessels. TAVI is often associated with bleeding and thromboembolic events. However, the effect of single and dual antiplatelet treatment for bleeding and thromboembolic events in patients with no long-term anticoagulation has not been well-studied. This study aims to evaluate the effect of aspirin with or without clopidogrel after TAVI.

This randomized, controlled trial included a total of 331 patients who were undergoing TAVI and had no indication for long-term anticoagulation.  The patients were randomly assigned in a 1:1 ratio to receive aspirin alone (n=331) or aspirin plus clopidogrel (n=334) for three months. The primary outcomes of the study were all bleeding and non-procedure-related bleeding.

A bleeding event was reported in 15.1% of patients in the aspirin alone group and 26.6% of patients in the aspirin-clopidogrel group. Non-procedure-related bleeding was reported in 15.1% in the aspirin only group and 24.9% of patients in the aspirin-clopidogrel group.  A secondary composite 1 event occurred in 23% in the aspirin group and 31.1% in the aspirin-clopidogrel group; a secondary composite 2 event occurred in 9.7% of patients in the aspirin group and 9.9% of patients in the aspirin-clopidogrel group.

The research concluded that patients undergoing TAVI who had no indication for anticoagulation witnessed significantly less bleeding with aspirin alone than with aspirin plus clopidogrel.

Ref: https://www.nejm.org/doi/full/10.1056/NEJMoa2017815