Mono versus Dual Antiplatelet Therapy after Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis

Khalil, Charl; Mosleh, Wassim; Megaly, Michael; Gandhi, Sumeet; Iskander, Fady; Iskander, Mina; Ibrahim, Ali K.; Shah, Tanvi; Ekladios, Catherine; Corbelli, John

doi:10.1080/24748706.2018.1495857

Cited by 2 publications

(1 citation statement)

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“…For instance, patients were more likely to be assigned to the DAPT group because of MI or PCI history and the SAPT group because of relative higher bleeding risk. Hence, great baseline heterogeneity between the two study groups in the observational studies leads to controversial results, as previous meta-analyses have revealed ( 20 , 21 ). Take all-cause death for example, DAPT showed no difference compared with SAPT in RCTs but had favorable effects in observational studies.…”

Section: Discussionmentioning

confidence: 99%

Dual Antiplatelet Therapy vs. Single Antiplatelet Therapy After Transcatheter Aortic Valve Replacement: An Updated Systematic Review and Meta-Analysis

Zhang

Shen

Yang

et al. 2021

Front. Cardiovasc. Med.

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Background: Although mainstream guidelines recommend dual antiplatelet therapy (DAPT) with aspirin and clopidogrel in patients following transcatheter aortic valve replacement (TAVR), it is not evidence-based. We aim to investigate the safety and efficacy of DAPT vs. single antiplatelet therapy (SAPT) after TAVR, and review updated evidence.Methods: We systematically searched PubMed, Embase, and Cochrane for studies comparing DAPT to SAPT after TAVR from inception to November 30, 2020. The primary outcome was major adverse cardiac and cerebrovascular events, including all-cause mortality, cardiovascular death, myocardial infarction (MI), stroke, and major or life-threatening bleeding (LTB). Subgroup analysis was performed according to study type (randomized control trials vs. observational studies) using a fixed-effects model. The quality of evidence was assessed by two scoring systems and GRADE (Grading of Recommendations Assessment, Development, and Evaluation).Results: Twelve studies of 20,766 patients were included in our meta-analysis. Compared with SAPT, DAPT was associated with an increased risk for combined life threatening and major bleeding [OR 1.73 (1.19–2.51), p = 0.004] after TAVR. Such a difference was largely driven by major bleeding [OR 2.29 (1.68–3.11), p < 0.001]. There were no significant differences on major adverse cardiovascular events (MACE) [OR 1.19 (0.99–1.44), p = 0.07], cardiovascular mortality [OR 1.46 (0.93–2.30), p = 0.10], and stroke [OR 0.97 (0.80–1.16), p = 0.71].Conclusions: Compared with SAPT, post-TAVR DAPT was associated with increased risks of major or life-threatening bleeding without additional benefits of reducing thrombotic events. Future guidelines for post-TAVR antiplatelet strategy are expected to be updated as new high-quality evidence emerges.Systematic Review Registration: PROSPERO, Identifier: CRD42021230075.

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Section: Discussionmentioning

confidence: 99%