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Aspirin Alone Versus Dual Antiplatelet Therapy after Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis

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Abstract

Background

The current American College of Cardiology and American Heart Association (ACC/AHA) guidelines recommend dual antiplatelet therapy (DAPT) with aspirin and clopidogrel for 6 months followed by lifelong aspirin after transcatheter aortic valve replacement (TAVR). However, studies that have DAPT with aspirin following TAVR have questioned this recommendation as DAPT has been associated with more bleeding events compared to aspirin. We performed a systematic review and meta-analysis of all the RCTs comparing DAPT (aspirin plus clopidogrel) with aspirin alone as antithrombotic treatment following transcatheter aortic valve replacement.

Methods

The databases of Embase, PubMed, and Cochrane library were searched from inception to Oct 1, 2020, and randomized controlled trials (RCTs) reporting aspirin plus clopidogrel with aspirin alone as antithrombotic treatment after TAVI were included. Revman 5.3 was used to conduct the analysis.

Results

After screening 152 articles, four studies involving 1086 patients (541 patients in the aspirin group and 545 patients in the DAPT group) were included. The results demonstrated that, at 30 days follow-up, compared with DAPT, aspirin was not associated with a statistically significant difference in the rate of bleeding events (RR = 1.22, 95% CI 0.62 to 2.39, P = 0.57), all-cause mortality (RR = 1.21, 95% CI 0.52 to 2.84, P = 0.66), stroke (RR = 0.81, 95% CI 0.24 to 2.79, P = 0.74), and MI (RR = 4.00, 95% CI 0.45 to 35.22, P = 0.21). However, at the 6 to 12 months follow-up, DAPT appeared to increase the risk of bleeding events compared with aspirin alone (RR = 1.67, 95% CI 1.24 to 2.24, P < 0.001), and there was no significant difference in the rate of all-cause mortality (RR = 0.89, 95% CI 0.53 to 1.48, P = 0.65), stroke (RR = 1.04, 95% CI 0.57 to 1.92, P = 0.90), and MI (RR = 1.65, 95% CI 0.52 to 5.26, P = 0.40) among the two groups.

Conclusions

Our systematic review and meta-analysis suggested that aspirin alone could decrease the risk of bleeding and was not associated with higher risk of mortality, stroke or myocardial infarction compared with DAPT.

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Data Availability

All data generated or analyzed during this study was included in the article.

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Code Availability

We conducted the statistical analysis in the present study using Review Manager version 5.3 (Cochrane Collaboration; Copenhagen, Denmark).

Funding

This study was supported by the National Natural Science Foundation of China (Grant Nos. 81800284), the Ministry of Science and Technology of China (Grant Nos.2019YFC0120705), the Science and Technology Foundation of Zhejiang Province of China (Grant Nos. BQ20H020001 and 2020C03018), the Science and Technology Foundation of Hangzhou of China (Grant Nos. 20191203B82), the Natural Science Foundation of Jiangsu Province of China (Grant Nos. BK20180144), the Zhejiang Natural Science Foundation (LY15H020003, LBQ20H020001), the Science Technology Department of Zhejiang Province (2016C33207), the Health and Family Planning Commission of Zhejiang Province (2016ZDB010), the Key research and development program of Zhejiang province (2020C03018), and Subproject of National key research and development program of China (2019YFC0120705).

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Author notes

  1. Xiaoxiao Lin, Shuai Wang, Long Wang, and Yihong Guan contributed equally to this work.

Authors and Affiliations

  1. Zhejiang Chinese Medical University, Hangzhou, China

    Xiaoxiao Lin & Yihong Guan

  2. Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Stress: No. 261, Huansha Road, Hangzhou, 310006, China

    Xiaoxiao Lin, Shuai Wang, Long Wang, Yihong Guan & Jinyu Huang

Authors
  1. Xiaoxiao Lin
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Contributions

All authors were responsible for the study conception and design. LXX and WS contributed to data extraction, assessment of study quality, analysis and interpretation of data, and drafting of the manuscript. The comprehensive literature search was completed by LXX and WS. HJY, GYH and WL critically evaluated and revised the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Jinyu Huang.

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The present study is a systematic review and meta-analysis, therefore ethics approval is not required.

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The authors declare that they have no competing interests.

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Lin, X., Wang, S., Wang, L. et al. Aspirin Alone Versus Dual Antiplatelet Therapy after Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis. Cardiovasc Drugs Ther 36, 271–278 (2022). https://doi.org/10.1007/s10557-021-07145-7

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