Author + information
- Abdulah Alrifai1,
- Mohamad Soud2,
- Amjad Kabach3,
- Yash Jobanputra1,
- M Chadi Alraies4 and
- Zaher Fanari5
- 1University of Miami/JFK Medical Center, Atlantis, FL
- 2MedStar Heart and Vascular Institute, Washington, DC
- 3Creighton University, School of medicine, Omaha, NE
- 4MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC
- 5Heartland Cardiology/Wesley Medical Center, University of Kansas School of Medicine, Wichita, KS
The current American College of Cardiology/American Heart Association (ACC/AHA) recommends empirical therapy with dual antiplatelet (DAPT) regimen of ASA and clopidogrel for six months after aortic valve replacement (TAVR). This recommendation is based on the expert consensus rather than clear clinical evidence. Given the lack of clear consensus on treatment strategy for ischemic events prevention following TAVR, we performed a meta-analysis of studies comparing aspirin based mono-antiplatelet therapy (MAPT) with DAPT in patients who have undergone TAVR.
We performed a systematic review and meta-analysis from randomized clinical trials (RCTs) and prospective studies that tested DAPT vs. MAPT for all-cause mortality and major bleeding. The primary efficacy outcomes were 30-days mortality and stroke. The primary safety outcomes were major bleeding and major vascular complications. Secondary safety outcomes included minor bleeding and minor vascular complications.
The meta-analysis included 603 patients with 301 receiving MAPT and 302 receiving DAPT. The use of MAPT was associated with similar mortality (MAPT 5.9% vs. the DAPT 6.6%; RR= 0.92; = 95% CI 0.49 to 1.71; P= 0.68) or in major strokes (1.3% vs. 1.3%; RR 1.04; 95% CI 0.27 to 4.04; P=0.81). MAPT was associated with significantly less risk of major bleeding (4.9% vs. 14.5%; RR 0.37; 95% CI 0.20 to 0.70; P<0.01). However there was no difference in major vascular complication (4.2% vs. 8.9%; RR 0.52; 95% CI 0.23 to 1.18; P=0.17), minor bleeding (4.2% vs. 3.6%; RR 1.16; 95% CI 0.43 to 3.10; P= 0.85) or minor vascular complication (4.2% vs. 7.3%; RR 0.58; 95% CI 0.25 to 1.34; P=0.14).
MAPT use post TAVR is associated with lower risk of major bleeding comparing to DAPT with no significant difference in mortality, stroke or vascular complications risk.