Single Anti-Platelet Therapy versus Dual Anti-Platelet Therapy after Transcatheter Aortic Valve Replacement: A Meta-Analysis

• Published in: Structural heart (Online) Vol. 2; no. 5; pp. 408 - 418
• Main Authors: Abuzaid, Ahmed, Ranjan, Pragya, Fabrizio, Carly, Felpel, Kevin, Chawla, Raveen, Topic, Adrienne, Elgendy, Islam Y.
• Format: Journal Article
• Language: English
• Published: Taylor & Francis 03.09.2018
• Subjects: Antiplatelet therapy; bleeding; meta-analysis; mortality; transcatheter aortic valve replacement
• ISSN: 2474-8706; 2474-8714
• DOI: 10.1080/24748706.2018.1491082

Background: The optimal anti-platelet regimen after transcatheter aortic valve replacement (TAVR) remains uncertain. The objective of this study was to compare the efficacy and safety of single anti-platelet therapy (SAPT) vs. dual anti-platelet therapy (DAPT) after transcatheter aortic valve replacement (TAVR). Methods: Electronic databases were searched for randomized and observational studies, which compared SAPT versus DAPT after TAVR. The primary outcomes were all-cause mortality, and major bleeding. Summary adjusted risk ratios (RR) were calculated using a Der-Simonian and Liard model. The risk of bias of the included studies was assessed by the Cochrane scale and New-castle Ottawa assessment tool. Results: A total of 10 studies with 2,412 patients were included. There was no difference in 30-days all-cause mortality (RR 1.19, 95% CI 0.79-1.81, p = 0.41, I 2  = 0.0%) and at the longest available follow up (i.e. mean 6.4 months) (RR 1.03, 95% CI 0.69-1.57, p = 0.86, I 2  = 0.0%). The risk of major bleeding was higher in the DAPT group (RR 2.14, 95% CI 1.37-3.31, p = 0.001). These findings were consistent on analyzing randomized versus observational studies (P interaction  = 0.97, and 0.76 for all-cause mortality and major bleeding, respectively). There was no difference in the risk of life-threatening bleeding, major vascular complications, myocardial infarction, and stroke between both groups (all p-values > 0.05). Conclusion: DAPT post TAVR is associated with an increased risk of major bleeding with no benefit on mortality, stroke, or myocardial infarction. The evidence is driven mainly from observational studies, and therefore future high quality randomized trials are needed.