A new analysis from the HOSTILE registry suggests that dual antiplatelet therapy (DAPT) may offer better one-year survival outcomes than single antiplatelet therapy (SAPT) in patients with severe peripheral artery disease (PAD) who were undergoing transcatheter aortic valve implantation (TAVI), without significantly raising the risk of bleeding. The findings were published in European Heart Journal - Cardiovascular Pharmacotherapy.

This multicenter, international, observational study evaluated 573 patients from the HOSTILE registry, drawn from 28 centers worldwide. All patients had hostile femoral access and underwent TAVI through transfemoral or non-thoracic alternative approaches. Those with atrial fibrillation were excluded. Among the patients, 144 received SAPT, while 429 were treated with DAPT post-TAVI.

At 30 days, DAPT showed a non-significant reduction in major adverse cardiovascular events (MACE), i.e., a composite of myocardial infarction, cardiovascular death,  and stroke or transient ischemic attack, compared to SAPT (HR 0.74, 95% CI 0.25–2.18; p=0.59). This trend persisted at 12 months (HR 0.89, 95% CI 0.35–2.24; p=0.80). Patients with more severe PAD may derive greater benefit from DAPT.

DAPT significantly reduced the risk of all-cause mortality at 12 months (HR 0.22, 95% CI 0.10–0.47; p<0.001) compared to SAPT; however, the difference at 30 days (HR 0.26, 95% CI 0.05–1.22; p=0.09) was not statistically significant. The use of DAPT did not increase the risk of major bleeding at either 30 days or 12 months. The study also found no increase in any bleeding at 30 days or 12 months.