Valvular & structural heart diseaseCohort study
Trends and Outcomes of Antithrombotic Strategies for Valve-in-Valve Transcatheter Aortic Valve Replacement (TAVR)
- Retrospective cohort study
- registry-based
- inverse probability of treatment weighting
Authors' conclusion
Analysis of a national U.S. registry revealed wide variation in antithrombotic regimens following ViV TAVR, likely reflecting the absence of robust evidence to guide treatment decisions. Although no differences in outcomes were identified in this large retrospective analysis
Study context
- Population
- Patients undergoing valve-in-valve (ViV) TAVR for degenerated aortic bioprostheses without established indications for dual antiplatelet therapy (DAPT) or oral anticoagulation (OAC), STS/ACC TVT Registry, January 2015–March 2024
- Participants
- 18,414 patients
- Exposure
- DAPT or OAC-based therapy vs single antiplatelet therapy (SAPT) after ViV TAVR
- Outcome
- All-cause mortality, stroke and bleeding
- Follow-up
- 1 year
Main finding
As reported in the abstract
Each group vs SAPTAdjusted hazard ratio (95% CI)
DAPTall-cause mortality
0.91(0.74–1.11)
OAC-based therapyall-cause mortality
1.14(0.89–1.46)
DAPTstroke
0.98(0.73–1.30)
OAC-based therapystroke
1.09(0.76–1.55)
DAPTbleeding
0.86(0.71–1.04)
OAC-based therapybleeding
0.88(0.70–1.11)
Observational data: associations, not effects.
Further findings
Antithrombotic strategy at discharge
Antithrombotic strategy at discharge
- Q1 2015 to Q1 2024: DAPT use significantly declined, SAPT use increased to become predominant; OAC-based therapy remained least used
- Proportion of each strategy among operators and sites ranged from nearly 0% to 100%
Safety
| Outcome | adjusted HR (95% CI) | |
|---|---|---|
| Bleeding · 1 year — DAPT vs SAPT | 0.86 (0.71–1.04) | |
| Bleeding · 1 year — OAC-based therapy vs SAPT | 0.88 (0.70–1.11) | |
| 0.512Adjusted hazard ratio (log scale) |
Original publication
Trends and Outcomes of Antithrombotic Strategies for Valve-in-Valve TAVR. JACC Cardiovasc Interv. Published 27 July 2026. doi:10.1016/j.jcin.2026.05.026
Summarised from the published abstract; every number is checked against it