Single versus dual anti-platelet therapy post transcatheter aortic valve implantation: a meta-analysis of randomized controlled trials
- 174 Downloads
The purpose of this systematic review and meta-analysis was to assess the 30-days safety (bleeding and vascular events) and efficacy (reduction in major stroke, myocardial infarction and mortality) of single anti-platelet (SAPT) versus dual anti-platelet (DAPT) after transcatheter aortic valve implantation (TAVI). We used a meta-analytic method with Mantel–Haenszel methods to calculate the odds ratio (OR) and 95% confidence interval (CI). Only randomized clinical trials that compared 30-days safety and efficacy based on Valve Academic Research Consortium criteria were included. Studies that included patients on anticoagulants were excluded. Our analysis included three studies with a total of 421 patients (210 SAPT and 211 DAPT). Life-threatening and major bleeding as well as major vascular complications was similar between SAPT and DAPT. Similarly, major stroke, myocardial infarction and mortality was also comparable between the two groups. The combined outcomes of 30-day mortality, life-threatening and major bleeding showed tendency toward lower event rates in SAPT compared to DAPT (9.5 vs. 15.6%, OR 0.57; 95% CI 0.31–1.03, p = 0.06). In conclusion, SAPT provided similar safety without adding incremental efficacy compared to DAPT but showed tendency of lower combined endpoints of 30-day mortality, life-threatening and major bleeding.
KeywordsTranscatheter aortic valve implantation Single antiplatelet therapy Dual antiplatelet therapy
There was no funding for this research.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
This was a systematic review of the previously published original articles and therefore in accordance with the ethical standards.
This was a systematic review of the previously published articles and therefore did not require approval from institutional board review.
- 3.Nishimura RA, Otto CM, Bonow RO et al (2014) 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Thorac Cardiovasc Surg 148:e1–e132CrossRefPubMedGoogle Scholar
- 4.Ussia GP, Scarabelli M, Mulè M, Barbanti M, Sarkar K, Cammalleri V, Immè S, Aruta P, Pistritto AM, Gulino S, Deste W, Capodanno D, Tamburino C. Dual (2011) antiplatelet therapy versus aspirin alone in patients undergoing transcatheter aortic valve implantation. Am J Cardiol 108:1772–1776CrossRefPubMedGoogle Scholar
- 5.Stabile E, Pucciarelli A, Cota L, Sorropago G, Tesorio T, Salemme L, Popusoi G, Ambrosini V, Cioppa A, Agrusta M, Catapano D, Moscariello C, Trimarco B, Esposito G, Rubino P (2014) SAT-TAVI (single antiplatelet therapy for TAVI) study: a pilot randomized study comparing double to single antiplatelet therapy for transcatheter aortic valve implantation. Int J Cardiol 174:624–627CrossRefPubMedGoogle Scholar
- 6.Huczek Z, Kochman J, Grygier M, Parma R, Scislo P, Wilimski R, Ochala A, Lesiak M, Olasinska-Wisniewska A, Grabowski M, Mazurek T, Sibbing D, Filipiak KJ, Opolski G (2015) Pre-procedural dual antiplatelet therapy and bleeding events following transcatheter aortic valve implantation (TAVI). Thromb Res 136:112–117CrossRefPubMedGoogle Scholar
- 7.Hioki H, Watanabe Y, Kozuma K, Nara Y, Kawashima H, Kataoka A, Yamamoto M, Takagi K, Araki M, Tada N, Shirai S, Yamanaka F, Hayashida K, On behalf of OCEAN-TAVI investigators (2017) Pre-procedural dual antiplatelet therapy in patients undergoing transcatheter aortic valve implantation increases risk of bleeding. Heart 103:361–367CrossRefPubMedGoogle Scholar
- 8.Czerwińska-Jelonkiewicz K, Zembala M, Dąbrowski M, Witkowski A, Ochała A, Kochman J, Dudek D, Kübler P, Jagielak D, Stępińska J (2017) Can TAVI patients receive aspirin monotherapy as patients after surgical aortic bioprosthesis implantation? Data from the Polish Registry—POL-TAVI. Int J Cardiol 227:305–311CrossRefPubMedGoogle Scholar
- 10.Ichibori Y, Mizote I, Maeda K, Onishi T, Ohtani T, Yamaguchi O, Torikai K, Kuratani T, Sawa Y, Nakatani S, Sakata Y (2017) Clinical outcomes and bioprosthetic valve function after transcatheter aortic valve implantation under dual antiplatelet therapy vs. aspirin alone. Circ J 81:397–404CrossRefPubMedGoogle Scholar
- 13.Aryal MR, Karmacharya P, Pandit A, Hakim F, Pathak R, Mainali NR, Ukaigwe A, Mahmood M, Badal M, Fortuin FD (2015) Dual versus single antiplatelet therapy in patients undergoing transcatheter aortic valve replacement: a systematic review and meta-analysis. Heart Lung Circ 24:185–192CrossRefPubMedGoogle Scholar