Antithrombotic therapy following transcatheter aortic valve implantation: a Danish nationwide study

BACKGROUND: Antithrombotic therapy post-transcatheter aortic valve implantation (TAVI) has been widely debated in the past two decades. Data describing practice patterns of antithrombotic therapy are warranted. This study examined the trends in use of antithrombotic therapy post-TAVI in Denmark.

METHODS: Danish patients with aortic stenosis who underwent first-time TAVI from 2008 to 2021 were identified from Danish registries. Patients were categorized according to atrial fibrillation (AF) status and antithrombotic therapy post-TAVI based on prescription fillings: no antithrombotic therapy, single antiplatelet therapy (SAPT), dual antiplatelet therapy (DAPT), oral anticoagulant therapy (OAC), and oral anticoagulant therapy with antiplatelet therapy (OAC+). Use of antithrombotic therapy among survivors at 15 months was examined to assess persistence and possible changes in treatment.

RESULTS: This study included 6447 patients undergoing TAVI. Among patients without AF (n = 3975), most patients received SAPT or DAPT. In AF patients (n = 2472), most patients received OAC or OAC+ . During the first 14 years of TAVI, there was a shift in the antithrombotic treatment pattern. For patients without AF, SAPT increased from 15.6% to 69.5%, with a concomitant decrease in DAPT from 56.3% to 9.1%. For AF patients, OAC increased from 13.0% to 77.9% and OAC+ decreased to 9.1%. Most patients without AF either remained with or shifted to SAPT. AF patients either remained in or shifted to the OAC group.

CONCLUSION: Antithrombotic therapy patterns post-TAVI have changed over the first 14 years of TAVI in Denmark. Use of DAPT and OAC+ decreased with a concomitant increase in SAPT and OAC.