The POPular TAVI trial. Antithrombotic therapy following TAVI: Towards a minimalist strategy

Abstract

Antithrombotic therapy following transcatheter aortic valve implantation (TAVI) has evolved empirically with dual antiplatelet therapy (DAPT, aspirin plus clopidogrel) currently recommended in the clinical guidelines. The pilot ARTE trial showed a higher risk of major/life-threatening bleeding events and no reduction of thromboembolic complications with the use of DAPT vs aspirin alone in TAVI recipients. The recently published POPular TAVI trial (NCT02247128) confirmed an increased risk of DAPT (vs. aspirin alone) following TAVI, which was associated with a significant increase in all bleeding events (primary endpoint) and no reduction of ischemic events (stroke, myocardial infarction) or death. Also, DAPT had no effects on the occurrence of clinically apparent valve thrombosis. While ongoing and future studies will have to determine the potential role of anticoagulation (vs antiplatelet) therapy as the antithrombotic treatment of TAVI, the evidence currently available strongly supports the use of single antiplatelet therapy (aspirin) in this setting. Thus, a minimalist approach with aspirin alone should urgently be adopted in the TAVI routine clinical practice and, therefore, implemented in the guidelines.