Systematic Review/Meta-analysisComparison of Dual-antiplatelet Therapy to Mono-antiplatelet Therapy After Transcatheter Aortic Valve Implantation: Systematic Review and Meta-analysis
Section snippets
Study selection
This meta-analysis was performed in accordance with PRISMA (Preferred Reporting Items for Systemic Reviews and Meta-Analyses) recommendations.5 A systematic search was conducted to retrieve studies that investigated DAPT compared with MAPT in patients who have undergone TAVI. We searched for candidate articles in PubMed, MEDLINE, EMBASE, and Cochrane databases from 1950-November 2014 using OVID software with the “explode” feature. The following keywords were used: (transcatheter aortic valve
Search results
Figure 1 outlines the search strategy. Our search strategy yielded 138 results, 69 of which were duplicate studies that were removed. Sixty-nine studies were screened, 48 of which were excluded on review of the title and abstract. A further 17 studies were excluded after careful review of the full text (7 observational studies that did not report the outcome of interest,7, 8, 9, 10, 11, 12, 13 9 review articles,14, 15, 16, 17, 18, 19, 20, 21, 22 and 1 meta-analysis23). Thus, 4 studies with 640
Discussion
The results of our study show that DAPT compared with MAPT in patients who have undergone TAVI demonstrated a trend toward an increase in the primary outcome measure of combined 30-day stroke, spontaneous MI, all-cause mortality, and combined lethal and major bleeding; this was driven by increased events in observational studies alone, with no difference in randomized studies. For the secondary outcome measures, there was increased risk of 30-day and 6-month combined lethal and major bleeding.
Conclusions
DAPT in comparison with MAPT in patients who have undergone TAVI suggested a trend toward increased harm caused by increased bleeding, with no observed benefit in reduction of 30-day and 6-month major stroke, spontaneous MI, and all-cause mortality. The trend toward increased harm is driven by observational studies, with no significant difference in randomized trials. The optimal antiplatelet regimen after TAVI is currently being studied in the ARTE trial. Future consideration should also be
Disclosures
The authors have no conflicts of interest to disclose.
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2022, American Journal of Emergency MedicineCitation Excerpt :In the U.S., patients are commonly placed on dual antiplatelet therapy for 3–6 months [132]. Observational data suggest increased risk of stroke, MI, mortality, and bleeding with dual antiplatelet therapy, but these results have not been replicated in randomized trials [133]. Emergency clinicians must be aware of the stroke risk in post-TAVR patients and the risk beyond the peri-procedural timeframe.
Predictors of Early Stroke or Death in Patients Undergoing Transcatheter Aortic Valve Implantation
2021, Journal of Stroke and Cerebrovascular DiseasesQuality deficits of drug trials for older patients: An analysis of a series of systematic reviews
2020, Zeitschrift fur Evidenz, Fortbildung und Qualitat im GesundheitswesenVariation in post-TAVR antiplatelet therapy utilization and associated outcomes: Insights from the STS/ACC TVT Registry
2018, American Heart JournalCitation Excerpt :Again, the investigators found no difference in rates of death (DAPT vs ASA 5% vs 5%) or stroke (DAPT vs ASA 1.7% vs 1.7%) during follow-up. Two recent systematic reviews have evaluated the published data on this topic, both studying a total of less than 600 patients undergoing TAVR.12,13 These studies again suggested that antiplatelet monotherapy may be similar in performance to DAPT.
Dual antiplatelet therapy versus single antiplatelet therapy after transaortic valve replacement: Meta-analysis
2018, Cardiovascular Revascularization Medicine
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