Antiplatelet therapy after transcatheter aortic valve implantation: a systematic review and meta-analysis. (20th January 2021)

• Record Type: Journal Article
• Authors: Costa, GonçaloNuno Ferraz; Costa, Marco; Gonçalves, Lino; Teixeira, Rogério
• Is Part Of: European journal of cardio-thoracic surgery. Volume 60:Number 5(2021)
• Page Start: 1022
• Page End: 1029
• Publication Date: 2021-01-20
• Subjects: Aspirin -- Clopidogrel -- Aortic stenosis; Heart -- Surgery -- Periodicals; Chest -- Surgery -- Periodicals; 617.54
• DOI: 10.1093/ejcts/ezab250
• Languages: English
• ISSNs: 1010-7940

Abstract

Abstract: : OBJECTIVES: The aim of this study was to compare antithrombotic regimens after transcatheter aortic valve implantation (TAVI) in patients without an indication for long-term anticoagulation. TAVI is a safe and effective approach for patients with symptomatic severe aortic stenosis and an intermediate-to-high surgical risk. Nevertheless, the antithrombotic regimen after procedure remains controversial. METHODS: We systematically searched PubMed, Embase and Cochrane databases for interventional studies comparing single antiplatelet therapy with double antiplatelet therapy after TAVI. A meta-analysis was carried out to compare thrombotic and bleeding events between both strategies. RESULTS: Four randomized clinical trials were included comprising a total of 1085 patients. Our meta-analysis revealed a higher odds ratio (OR) of major bleeding events (pooled OR 2.45, 95% confidence interval (CI) 1.29–4.67; P < 0.01; I 2 = 0%) and minor bleeding (pooled OR 1.73, 95% CI 1.12–2.66; P = 0.01; I 2 = 0%) for the double antiplatelet therapy group compared with the single antiplatelet therapy group. There was no difference between groups in the risk of stroke (pooled OR 1.04, 95% CI 0.58–1.86; P = 0.91; I 2 = 0%), myocardial infarction (pooled OR 2.10, 95% CI 0.75–5.84; P = 0.16, I 2 = 0%) and all-cause mortality (pooled OR 1.07, 95% CI 0.63–1.86; P = 0.08; I 2 = 0%) after TAVI. CONCLUSIONS: Our pooled analysis suggests that for patients who underwent TAVI, double antiplatelet therapy compared with single antiplatelet therapy alone increased the risk of bleeding without reducing mortality and ischaemic events.