After TAVI, anticoagulants outperform antiplatelet agents at preventing clots
After transcatheter aortic valve implantation (TAVI), anticoagulation reduced imaging signs of clot formation on the new valve compared with antiplatelet therapy, without compromising safety. This was the main finding of the ACASA-TAVI trial presented in a Hot Line session at ESC Congress 2026 and published simultaneously in JAMA.
In the ACASA-TAVI trial, anticoagulation therapy proven more effective than antiplatelet therapy in preventing clot formation on bioprosthetic heart valves after transcatheter aortic valve implantation (TAVI). This finding was presented at the ESC Congress 2026 and published in JAMA. The study, led by Dr. Øyvind Lie from Oslo University Hospital, involved 360 patients aged 65-80 who underwent successful TAVI and were randomly assigned to receive either a non-vitamin K antagonist oral anticoagulant (NOAC) or acetylsalicylic acid (ASA) for 12 months.
The primary efficacy result showed a 45% reduction in imaging signs of leaflet thrombosis with NOACs compared to ASA (17.2% vs. 32.6%; risk ratio 0.55). The safety analysis revealed noninferiority of NOACs to ASA for the primary safety endpoint (7.5% vs. 10.6%; risk difference -3.3). The study suggests a new antithrombotic treatment approach for TAVI patients, potentially influencing future guidelines.
The trial will continue monitoring participants for a 10-year period to assess the impact of NOAC monotherapy on valve durability and clinical outcomes.
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