Meta-Analysis Comparing Dual Antiplatelet Therapy Versus Single Antiplatelet Therapy Following Transcatheter Aortic Valve Implantation
Section snippets
Methods
We performed a systematic literature review in PubMed, MEDLINE, SCOPUS, and Cochrane for all the related articles until December 2017. Search terms included “TAVR,” “TAVI,” “Transcatheter aortic valve replacement,” “antithrombotic agents,” “antiplatelet agents,” “dual antiplatelet therapy,” “single antiplatelet,” “aspirin,” and “DAPT”. All the results were downloaded to EndNote; a citation manager and duplicate citations were removed. We included all randomized controlled trials (RCT) and
Results
Three randomized trials6, 7, 8 and 4 nonrandomized studies4, 5,10, 11 involving 1,389 patients were included, of which 772 patients received DAPT and 617 received SAPT. The baseline characteristics were similar between the 2 treatment arms. The mean age of the population studied was 82years and included 55.6% females. Two studies5, 6 used Medtronic CoreValve only and 3 studies7, 8,10 used Edward's SAPIEN XT valve whereas Durand et al4 used both Medtronic CoreValve and Edward's SAPIEN XT valve (
Discussion
In this meta-analysis, we analyzed the outcomes at 30days and up to 6 to 12 months from all the RCTs and observational studies that compared DAPT to SAPT after TAVI. The results of our study show that DAPT after TAVI significantly increases LTB and significant bleeding when compared with SAPT without any benefit in ischemic and thromboembolic endpoints.
The rate of stroke after TAVI in various trials has been reported to be 1.2% to 6%.14, 15, 16 Stroke after TAVI is classified as acute (<24
Disclosures
The authors have no conflicts of interest to disclose.
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2019, Interventional Cardiology ClinicsCitation Excerpt :Given that over half of embolic protection devices seem to captured thrombotic debris—presumably related to perturbation of Virchow’s triad—the impact of periprocedural DAPT loading on short-term and long-term outcomes requires ongoing study. Several study-level meta-analyses have attempted to compare SAPT versus DAPT following TAVR.11,61,62 Fernandes Gilson and colleagues,61 in their meta-analysis of 691 patients treated with SAPT or DAPT following TAVR, showed no significant differences between treatment regimens at 30 days (OR = 0.88, 95% CI, 0.49–1.58; P = .67) and between 3 and 12 months (OR = 0.79, 95% CI, 0.45–1.38; P = .41).
Aspirin Alone Versus Dual Antiplatelet Therapy after Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis
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2021, Current Opinion in Cardiology
Funding: The study and the authors did not receive any financial support.