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

2021 ◽  
Vol 8 ◽  
Author(s):  
Yipeng Zhang ◽  
Lan Shen ◽  
Wentao Yang ◽  
Ben He
Keyword(s):  
Systematic Review ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Antiplatelet Therapy ◽  
Major Bleeding ◽  
Transcatheter Aortic Valve Replacement ◽  
Dual Antiplatelet Therapy ◽  
Meta Analysis ◽  
Transcatheter Aortic Valve ◽  
Life Threatening

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.

scholarly journals Duration of Antiplatelet Therapy Following Transcatheter Aortic Valve Replacement: Systematic Review and Network Meta‐Analysis

2021 ◽  
Author(s):  
Toshiki Kuno ◽  
Yujiro Yokoyama ◽  
Alexandros Briasoulis ◽  
Makoto Mori ◽  
Masao Iwagami ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Antiplatelet Therapy ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Therapy Group ◽  
Meta Analysis ◽  
Transcatheter Aortic Valve ◽  
All Cause Mortality ◽  
Life Threatening

Background Although current guidelines recommend dual antiplatelet therapy (DAPT) for 3 to 6 months following transcatheter aortic valve replacement (TAVR), there are no studies directly comparing outcomes of different durations of DAPT following TAVR. Methods and Results PubMed, EMBASE, and Cochrane Database were searched through November 2020 to identify clinical studies that investigated single antiplatelet therapy versus DAPT use following TAVR. Studies using oral anticoagulants and antiplatelet therapy concomitantly were excluded. The DAPT group was subdivided by the duration of DAPT. We extracted the risk ratios (RRs) of major or life‐threatening bleeding, stroke, and all‐cause mortality. Four randomized controlled trials, 2 propensity‐score matched studies, and 1 observational study were identified, yielding a total of 2498 patients who underwent TAVR assigned to the single antiplatelet therapy group (n=1249), 3‐month DAPT group (n=485), or 6‐month DAPT group (n=764). Pooled analyses demonstrated that when compared with the single antiplatelet therapy group, the rates of major or life‐threatening bleeding were significantly higher in the 3‐ and 6‐month DAPT groups (RR [95% CI]=2.13 [1.33–3.40], P =0.016; RR [95% CI]=2.54 [1.49–4.33], P =0.007, respectively) with no difference between the 3‐month DAPT versus 6‐month DAPT groups. The rates of stroke and all‐cause mortality were similar among the 3 groups. Conclusions In this network meta‐analysis of antiplatelet therapy following TAVR, single antiplatelet therapy with aspirin had lower bleeding without increasing stroke or death when compared with either 3‐ or 6‐month DAPT.

scholarly journals Single antiplatelet therapy versus dual antiplatelet therapy after transcatheter aortic valve replacement: a meta-analysis of randomized controlled trials

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
G Sayat ◽  
L G Porciuncula ◽  
A Gerodias
Keyword(s):  
Myocardial Infarction ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Antiplatelet Therapy ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Dual Antiplatelet Therapy ◽  
Meta Analysis ◽  
Randomized Controlled ◽  
Transcatheter Aortic Valve

Abstract Background The performance of transcatheter aortic valve replacement (TAVR) has expanded considerably during the past decade. Technological advances and refinement in implantation techniques have resulted in improved procedural outcomes, whereas indications are progressively extending toward lower-risk patients. Ischemic/embolic complications and major bleeding remain important and strongly correlate to mortality. In this regard, the optimal antithrombotic regimen after successful transcatheter aortic valve replacement remains unclear. Purpose To compare the efficacy and safety of single antiplatelet therapy (SAPT) versus dual antiplatelet therapy (DAPT) for post Transcatheter Aortic Valve Replacement. Search strategy Key Terms: transcatheter aortic valve replacement, transcatheter aortic valve implantation, antiplatelet, single antiplatelet therapy, dual antiplatelet therapy. Selection criteria Four randomized, controlled clinical trials comparing single antiplatelet therapy versus dual antiplatelet therapy for post TAVR patients were included in this study. Method Extensive search of PubMed, Medline, Cochrane and Ovid was done for articles published until November 20, 2020. Studies were limited to RCTs comparing SAPT and DAPT among patients who underwent TAVR. Outcome measures include: stroke, myocardial infarction, all-cause mortality and major bleeding. Two reviewers independently reviewed the studies. Results were gathered from published articles, journals and clinical trials. Studies were critically appraised with regards to methods of minimizing bias. All four studies included received a quality scale for meta-analysis overall score of not less than B. Statistical analysis was done using Review manager V5.4. Main results Four RCTs with 1086 patients were included in this meta-analysis. Overall, the risk of stroke (OR 0.94 [0.54 −1.64]), myocardial infarction (OR 0.50 [0.18–1.40]), and overall mortality (OR 1.01 [0.65–1.57]) did not differ significantly between DAPT and SAPT. There was noted increased risk of bleeding noted with DAPT, thus favoring SAPT (OR 0.44 [0.30–0.65]). Author's conclusions Among patients who underwent TAVR, DAPT compared to SAPT had similar rates of stroke, myocardial infarction and death. Due to lower rates of bleeding, we recommend using single antiplatelet therapy after TAVR. FUNDunding Acknowledgement Type of funding sources: None.

Abstract 15428: Network Meta-analysis of Duration of Antiplatelet Therapy Following Transcatheter Aortic Valve Replacement

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Yujiro Yokoyama ◽  
Toshiki Kuno ◽  
Alexandros BRIASOULIS ◽  
Makoto Mori ◽  
Masao Iwagami ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Antiplatelet Therapy ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Meta Analysis ◽  
Transcatheter Aortic Valve ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Life Threatening

Background: Although current guidelines recommend dual antiplatelet therapy (DAPT) for 3 to 6 months following transcatheter aortic valve replacement (TAVR), there are no studies directly comparing outcomes of different durations of DAPT following TAVR. Methods: Pubmed and EMBASE were searched through May, 2020 to identify clinical studies that investigated single antiplatelet therapy (SAPT) versus DAPT use following TAVR. Studies using oral anticoagulants and antiplatelet therapy concomitantly were excluded. The DAPT group was subdivided by the duration of DAPT. We extracted the risk ratios (RRs) of major or life-threatening bleeding, stroke, and all-cause mortality. Results: Three randomized controlled trials, two propensity-score matched studies, and one observational study were identified, yielding a total of 1,833 patients who underwent TAVR assigned to the SAPT group (n=918), 3-month DAPT group (n=151), or 6-month DAPT group (N=764). Pooled analyses demonstrated that the rates of major or life-threatening bleeding were significantly higher in the 6-month DAPT group compared with the SAPT group (RR [95% CI] =2.54 [1.49-4.33], P =0.007) while no such difference was observed between the SAPT vs. 3-month DAPT groups or the 3-month DAPT vs. 6-month DAPT groups (Figure). P-scores were 98.1% (SAPT), 32.3% (3-month DAPT), and 19.6% (6-month DAPT). The rates of stroke and all-cause mortality were similar among the groups. Conclusions: In our network meta-analysis, we observed that DAPT for 6 months following TAVR was associated with increased risk of bleeding without decreasing the risk of stroke compared with SAPT, while there was no difference between DAPT for 3 months and 6 months.

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