Hemodynamic Effects and Clinical Safety of Antiplatelet Strategies Following TAVI

All articles of this category (opens in new window) Background: Optimal antiplatelet therapy after transcatheter aortic valve implantation (TAVI) has evolved in recent years. Current guidelines clearly recommend single antiplatelet therapy (SAPT) with aspirin in most patients without a long-term indication for oral anticoagulation, primarily to reduce bleeding risk. DAPT is now reserved for specific scenarios such as recent PCI or acute coronary syndrome, which historically were the main indications for dual therapy after TAVI. However, data on the impact of different antiplatelet regimens on hemodynamic valve performance and clinical outcomes remain limited. Methods: This single-center study (2011–2024) included 2.266 patients receiving TAVI, discharged on either SAPT or dual antiplatelet therapy (DAPT). Primary endpoint for hemodynamic valve performance was defined as mean and peak transvalvular gradients and effective orifice area (EOA) at discharge and the latest available follow-up. Secondary endpoints included stroke/transient ischemic attack (TIA) and major or life-threatening bleeding according to VARC-3 criteria. Follow-up durations were derived from procedural and follow-up dates, and outcomes were analyzed separately for SAPT and DAPT, respectively. Results: Valve types were distributed as follows: SAPT—balloon-expandable valve (BEV) 42%, self-expanding valve (SEV) 58%; DAPT—BEV 44%, SEV 56%. Median follow-up duration was 396 ± 432 days for DAPT and 302 ± 368 days for SAPT ( p < 0.001). Discharge mean and peak gradients were similar between SAPT and DAPT, whereas the DAPT cohort showed lower EOA (mean gradients: 10 ± 4.8 mmHg vs. 10 ± 4.7 mmHg, p = 0.553; peak gradients: 19 ± 8.5 mmHg for both, p = 0.209; EOA: 1.9 ± 0.5 cm 2 vs. 1.8 ± 0.4 cm 2 , p = 0.002). At follow-up, SAPT and DAPT showed comparable mean gradients (11 ± 7.6 mmHg vs. 10 ± 5.1 mmHg, p = 0.528), peak gradients (20 ± 12 mmHg vs. 19 ± 8.6 mmHg, p = 0.378), and EOA (1.7 ± 0.5 cm 2 vs. 1.7 ± 0.4 cm 2 , p = 0.902). Short-term and follow-up TIA/ischemic stroke rates (2.6% vs. 2.9%; p = 0.688 and 4.5% vs. 2.7%; p = 0.051) did not differ significantly. Major or life-threatening short-term bleeding events were comparable for SAPT and DAPT (3.0% vs. 3.8%, p = 0.276). Conclusion: Compared to DAPT, SAPT after TAVI was associated with comparable hemodynamic valve performance during follow-up and similar rates of thromboembolic events with respect to TIA and Stroke, as well as for major or life-threatening bleeding complications. These findings support SAPT as a safe and potentially advantageous antiplatelet strategy post-TAVI. Publication History Article published online: 17 February 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany