Dual Versus Single Antiplatelet Therapy in Patients Undergoing Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-analysis

Madan Raj Aryal, Paras Karmacharya, Anil Pandit, Fayaz Hakim, Ranjan Pathak, Naba Raj Mainali, Anene Ukaigwe, Maryam Mahmood, Madan Badal, F. David Fortuin

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)185-192
Number of pages8
JournalHeart Lung and Circulation
Volume24
Issue number2
DOIs
StatePublished - Feb 1 2015

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Meta-Analysis
Therapeutics
Hemorrhage
clopidogrel
Stroke
Transcatheter Aortic Valve Replacement
Aspirin
Odds Ratio

Keywords

  • Dual antiplatelet therapy
  • Meta-analysis
  • Single antiplatelet therapy
  • Systematic review
  • Transcatheter aortic valve replacement

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Pulmonary and Respiratory Medicine

Cite this

Dual Versus Single Antiplatelet Therapy in Patients Undergoing Transcatheter Aortic Valve Replacement : A Systematic Review and Meta-analysis. / Aryal, Madan Raj; Karmacharya, Paras; Pandit, Anil; Hakim, Fayaz; Pathak, Ranjan; Mainali, Naba Raj; Ukaigwe, Anene; Mahmood, Maryam; Badal, Madan; Fortuin, F. David.

In: Heart Lung and Circulation, Vol. 24, No. 2, 01.02.2015, p. 185-192.

Research output: Contribution to journalArticle

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 and Circulation, vol. 24, no. 2, pp. 185-192. https://doi.org/10.1016/j.hlc.2014.07.058
Aryal, Madan Raj ; Karmacharya, Paras ; Pandit, Anil ; Hakim, Fayaz ; Pathak, Ranjan ; Mainali, Naba Raj ; Ukaigwe, Anene ; Mahmood, Maryam ; Badal, Madan ; Fortuin, F. David. / Dual Versus Single Antiplatelet Therapy in Patients Undergoing Transcatheter Aortic Valve Replacement : A Systematic Review and Meta-analysis. In: Heart Lung and Circulation. 2015 ; Vol. 24, No. 2. pp. 185-192.
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abstract = "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.",
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T2 - A Systematic Review and Meta-analysis

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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

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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.

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KW - Meta-analysis

KW - Single antiplatelet therapy

KW - Systematic review

KW - Transcatheter aortic valve replacement

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