TY - JOUR
T1 - Dual Versus Single Antiplatelet Therapy in Patients Undergoing Transcatheter Aortic Valve Replacement
T2 - A Systematic Review and Meta-analysis
AU - Aryal, Madan Raj
AU - Karmacharya, Paras
AU - Pandit, Anil
AU - Hakim, Fayaz
AU - Pathak, Ranjan
AU - Mainali, Naba Raj
AU - Ukaigwe, Anene
AU - Mahmood, Maryam
AU - Badal, Madan
AU - Fortuin, F. David
N1 - Publisher Copyright:
© 2014 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ).
PY - 2015/2/1
Y1 - 2015/2/1
N2 - Background: Although dual antiplatelet therapy (DAPT) with clopidogrel and aspirin is a widely accepted strategy in patients undergoing transcatheter aortic valve replacement (TAVR), this approach is not evidence based. We therefore sought to systematically review the current evidence for this practice in terms of 30-day outcome looking at stroke, MI, bleeding, and death. Methods: Relevant studies were identified through electronic literature search. Studies involving single antiplatelet therapy (SAPT) and DAPT in patients undergoing TAVR were included. Study specific risk ratios were calculated and combined using random-effects model meta-analysis. Results: Analysis of data from 410 patients, stroke occurred in seven (3.16%) of SAPT and six (3.17%) of DAPT RR. =. 1.03 (95% CI, 0.36-2.96, P. =. 0.96). In analysis of 530 patients, MI occurred in three (1.07%) of SAPT and one (0.40%) of DAPT RR. =. 1.97 (95% CI, 0.29-13.29, P. =. 0.49), significant bleeding (major, life threatening and bleeding requiring transfusion) occurred in 20 (7.11%) of SAPT and 43 (17.27%) of DAPT RR. =. 0.41 (95% CI, 0.25-0.69, P. =. 0.0006). Number needed to harm for major or life threatening bleeding was 10. Death occurred in 15 (6.78%) of SAPT and 15 (7.94%) of DAPT (RR 0.91; 95% CI 0.46-1.79, P. =. 0.78). Conclusion: Our meta-analysis suggests that at 30 days following TAVR there is no difference between post-procedural SAPT versus DAPT for the risk of stroke or MI and DAPT may have a higher bleeding risk. Adequately powered RCTs are warranted to clarify the optimal antiplatelet treatment strategy following TAVR.
AB - Background: Although dual antiplatelet therapy (DAPT) with clopidogrel and aspirin is a widely accepted strategy in patients undergoing transcatheter aortic valve replacement (TAVR), this approach is not evidence based. We therefore sought to systematically review the current evidence for this practice in terms of 30-day outcome looking at stroke, MI, bleeding, and death. Methods: Relevant studies were identified through electronic literature search. Studies involving single antiplatelet therapy (SAPT) and DAPT in patients undergoing TAVR were included. Study specific risk ratios were calculated and combined using random-effects model meta-analysis. Results: Analysis of data from 410 patients, stroke occurred in seven (3.16%) of SAPT and six (3.17%) of DAPT RR. =. 1.03 (95% CI, 0.36-2.96, P. =. 0.96). In analysis of 530 patients, MI occurred in three (1.07%) of SAPT and one (0.40%) of DAPT RR. =. 1.97 (95% CI, 0.29-13.29, P. =. 0.49), significant bleeding (major, life threatening and bleeding requiring transfusion) occurred in 20 (7.11%) of SAPT and 43 (17.27%) of DAPT RR. =. 0.41 (95% CI, 0.25-0.69, P. =. 0.0006). Number needed to harm for major or life threatening bleeding was 10. Death occurred in 15 (6.78%) of SAPT and 15 (7.94%) of DAPT (RR 0.91; 95% CI 0.46-1.79, P. =. 0.78). Conclusion: Our meta-analysis suggests that at 30 days following TAVR there is no difference between post-procedural SAPT versus DAPT for the risk of stroke or MI and DAPT may have a higher bleeding risk. Adequately powered RCTs are warranted to clarify the optimal antiplatelet treatment strategy following TAVR.
KW - Dual antiplatelet therapy
KW - Meta-analysis
KW - Single antiplatelet therapy
KW - Systematic review
KW - Transcatheter aortic valve replacement
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U2 - 10.1016/j.hlc.2014.07.058
DO - 10.1016/j.hlc.2014.07.058
M3 - Article
C2 - 25240570
AN - SCOPUS:84921472321
SN - 1443-9506
VL - 24
SP - 185
EP - 192
JO - Heart Lung and Circulation
JF - Heart Lung and Circulation
IS - 2
ER -