Journal of Thrombosis and Thrombolysis

, Volume 44, Issue 4, pp 448–456 | Cite as

Single versus dual anti-platelet therapy post transcatheter aortic valve implantation: a meta-analysis of randomized controlled trials

  • Tomo Ando
  • Hisato Takagi
  • Alexandros Briasoulis
  • Luis Afonso


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.


Transcatheter 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.

Ethical standards

This was a systematic review of the previously published original articles and therefore in accordance with the ethical standards.

Ethical approval

This was a systematic review of the previously published articles and therefore did not require approval from institutional board review.

Supplementary material

11239_2017_1550_MOESM1_ESM.tiff (25.8 mb)
Supplementary material 1—Flow chart of study selection (TIFF 26369 KB)


  1. 1.
    Kapadia SR, Leon MB, Makkar RR et al (2015) 5-year outcomes of transcatheter aortic valve replacement compared with standard treatment for patients with inoperable aortic stenosis (PARTNER 1): a randomised controlled trial. The Lancet 385:2485–2491CrossRefGoogle Scholar
  2. 2.
    Reardon MJ, Van Mieghem NM, Popma JJ et al (2017) Surgical or transcatheter aortic-valve replacement in intermediate-risk patients. N Engl J Med 376:1321–1331CrossRefPubMedGoogle Scholar
  3. 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. 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. 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. 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. 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. 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
  9. 9.
    Mangieri A, Jabbour RJ, Montalto C et al (2017) Single-antiplatelet therapy in patients with contraindication to dual-antiplatelet therapy after transcatheter aortic valve implantation. Am J Cardiol 119:1088–1093CrossRefPubMedGoogle Scholar
  10. 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
  11. 11.
    Rodés-Cabau J, Masson JB, Welsh RC et al (2017) The ARTE (aspirin versus aspirin + clopidogrel following transcatheter aortic valve implantation) Randomized Clinical Trial. JACC Cardiovasc Interv. doi: 10.1016/j.jcin.2017.04.014 Google Scholar
  12. 12.
    Gandhi S, Schwalm JD, Velianou JL, Natarajan MK, Farkouh ME (2015) Comparison of dual-antiplatelet therapy to mono-antiplatelet therapy after transcatheter aortic valve implantation: systematic review and meta-analysis. Can J Cardiol 31:775–784CrossRefPubMedGoogle Scholar
  13. 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
  14. 14.
    Hassell ME, Hildick-Smith D, Durand E et al (2015) Antiplatelet therapy following transcatheter aortic valve implantation. Heart 101:1118–1125CrossRefPubMedGoogle Scholar
  15. 15.
    Kappetein AP, Head SJ, Généreux P et al (2012) Updated standardized endpoint definitions for transcatheter aortic valve implantation: the Valve Academic Research Consortium-2 consensus document. J Am Coll Cardiol 60:1438–1454CrossRefPubMedGoogle Scholar
  16. 16.
    Leon MB, Piazza N, Nikolsky E et al (2011) Standardized endpoint definitions for Transcatheter Aortic Valve Implantation clinical trials: a consensus report from the Valve Academic Research Consortium. J Am Coll Cardiol 57:253–269CrossRefPubMedGoogle Scholar
  17. 17.
    Ando T, Akintoye E, Telila T, Briasoulis A, Takagi H, Grines CL, Afonso L (2017) Trends in vascular complications in high-risk patients following transcatheter aortic valve replacement in the United States. Am J Cardiol 119:1433–1437CrossRefPubMedGoogle Scholar
  18. 18.
    Chakravarty T, Søndergaard L, Friedman J et al (2017) Subclinical leaflet thrombosis in surgical and transcatheter bioprosthetic aortic valves: an observational study. The Lancet 389:2383–2392CrossRefGoogle Scholar
  19. 19.
    Abdul-Jawad Altisent O, Durand E, Muñoz-García AJ et al (2016) Warfarin and antiplatelet therapy versus warfarin alone for treating patients with atrial fibrillation undergoing transcatheter aortic valve replacement. JACC Cardiovasc Interv 9:1706–1717CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Tomo Ando
    • 1
    • 4
  • Hisato Takagi
    • 2
  • Alexandros Briasoulis
    • 3
  • Luis Afonso
    • 1
  1. 1.Division of Cardiovascular Disease, Department of Internal Medicine, Harper hospitalWayne State UniversityDetroitUSA
  2. 2.Division of Cardiovascular Surgery, Department of SurgeryShizuoka Medical CenterShizuokaJapan
  3. 3.Division of Cardiovascular Disease, Department of Internal MedicineMayo ClinicRochesterUSA
  4. 4.Division of CardiologyDetroit Medical CenterDetroitUSA

Personalised recommendations