Valvular & structural heart disease
Single vs. dual antiplatelet therapy in patients with severe peripheral arterial disease undergoing transcatheter aortic valve implantation: insights from the Hostile registry
Authors' conclusion
In TAVI patients with severe PAD, DAPT was associated with a trend towards improved outcomes compared with SAPT, particularly in those with higher PAD severity. These findings, including the observed reduction in 1-year mortality with DAPT, warrant further investigation in prospective studies.
Study context
- Population
- Patients without atrial fibrillation (AF) with hostile femoral access (severe peripheral artery disease (PAD)) undergoing transcatheter aortic valve implantation (TAVI) through transfemoral or non-thoracic alternative approachpatients without AF treated through transfemoral or non-thoracic alternative approach, of 1707 patients in the HOSTILE registry
- Participants
- 573 patients
- Exposure
- Dual antiplatelet therapy (DAPT) compared with single antiplatelet therapy (SAPT)
- DAPTn = 429
- SAPTn = 144reference
- Outcome
- Propensity-adjusted rate of major adverse cardiovascular events (MACE):
- Cardiovascular death
- Myocardial infarction
- Stroke
- Transient ischaemic attack
- Follow-up
- 30 days and 12 months
Methodological detailsconsecutive patients, 28 international centres, propensity-adjusted
- Consecutive patients
- 28 international centres
- Propensity-adjusted
Main finding
As reported in the abstract
DAPT vs SAPTHazard ratio (95% CI)P value
30 days; non-significant reduction
0.74(0.25–2.18)
P = 0.5912 months
0.89(0.35–2.24)
P = 0.80Observational data: associations, not effects.
Further findings
| Outcome | HR (95% CI) | P value | |
|---|---|---|---|
| All-cause death · 30 days and 12 monthsDAPTvs SAPT12 months | 0.22 (0.10–0.47) | P < 0.001 | |
| All-cause death · 30 days and 12 monthsDAPTvs SAPT30 days | 0.26 (0.05–1.22) | P = 0.09 | |
| 0.050.21520Hazard ratio (log scale) |
Safety
Major bleeding (primary safety endpoint, propensity-adjusted) · 30 days and 12 months
- No difference between groups at 30 days
- P = 0.13
- No difference between groups at 12 months
- P = 0.10
Any bleeding · 30 days and 12 months
- No difference between groups at 30 days
- P = 0.16
- No difference between groups at 12 months
- P = 0.17
Original publication
Single vs. dual antiplatelet therapy in patients with severe peripheral arterial disease undergoing transcatheter aortic valve implantation: insights from the Hostile registry. Eur Heart J Cardiovasc Pharmacother. Published 15 July 2025. doi:10.
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