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Aspirin Versus Dual Antiplatelet Therapy in Patients Undergoing Trans-Catheter Aortic Valve Implantation, Updated Meta-Analysis

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Abstract

Background

The Antiplatelet Therapy for Patients Undergoing Transcatheter Aortic-Valve Implantation (POPular TAVI) trial reported comparable composite endpoints of ischemic events using aspirin compared to dual antiplatelet therapy (DAPT). However, this trial was not powered to detect individual differences in ischemic events. We sought to conduct a meta-analysis to compare aspirin to DAPT on ischemic and bleeding events following TAVI.

Methods

The MEDLINE database was searched from inception until September 2020 and only randomized clinical trials of patients receiving antiplatelet therapy following TAVI were included. The treatment effect was reported as rate ratios (RRs) with 95% confidence intervals.

Results

Four randomized clinical trials of 1086 TAVI patients were included. There was a 51% reduction in major or life-threatening bleeding with aspirin compared with DAPT [RR 0.49, (95%CI 0.31 to 0.78)]. Aspirin was not associated with an increased risk of death [RR 1.01, (95%CI 0.62 to 1.65)], cardiovascular death [RR 1.15, (95%CI 0.56 to 2.36)], ischemic stroke [RR 0.93, (95%CI 0.51 to 1.70)], or MI [RR 0.53, (95%CI 0.18 to 1.57)].

Conclusions

This meta-analysis supports the use of aspirin as the optimal antiplatelet strategy following TAVI procedures in reducing bleeding without an increase in ischemic events compared with dual antiplatelet therapy.

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Data Availability

The data supporting the findings of this study are available from the corresponding author upon reasonable request.

References

  1. Baumgartner H, Falk V, Bax JJ, De Bonis M, Hamm C, Holm PJ, et al. 2017 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J. 2017;38:2739–91.

    Article  Google Scholar 

  2. Brouwer J, Nijenhuis VJ, Delewi R, Hermanides RS, Holvoet W, Dubois CLF, Frambach P, De Bruyne B, van Houwelingen GK, Van Der Heyden JAS, Tousek P, van der Kley F, Buysschaert I, Schotborgh CE, Ferdinande B, van der Harst P, Roosen J, Peper J, Thielen FWF, Veenstra L, Chan Pin Yin D, Swaans MJ, Rensing B, van ’t Hof AWJ, Timmers L, Kelder JC, Stella PR, Baan J, Ten Berg JM. Aspirin with or without clopidogrel after transcatheter aortic-valve implantation. N Engl J Med. 2020;383:1447–1457

  3. Rodes-Cabau J, Masson JB, Welsh RC, Garcia Del Blanco B, Pelletier M, Webb JG, et al. Aspirin versus aspirin plus clopidogrel as antithrombotic treatment following transcatheter aortic valve replacement with a balloon-expandable valve: the ARTE (aspirin versus aspirin + clopidogrel following transcatheter aortic valve implantation) randomized clinical trial. JACC Cardiovasc Interv. 2017;10:1357–65.

    Article  Google Scholar 

  4. Stabile E, Pucciarelli A, Cota L, Sorropago G, Tesorio T, Salemme L, et al. SAT-TAVI (single antiplatelet therapy for TAVI) study: a pilot randomized study comparing double to single antiplatelet therapy for transcatheter aortic valve implantation. Int J Cardiol. 2014;174:624–7.

    Article  Google Scholar 

  5. Ussia GP, Scarabelli M, Mule M, Barbanti M, Sarkar K, Cammalleri V, et al. Dual antiplatelet therapy versus aspirin alone in patients undergoing transcatheter aortic valve implantation. Am J Cardiol. 2011;108:1772–6.

    Article  CAS  Google Scholar 

  6. Guedeney P, Mehran R, Collet JP, Claessen BE, Ten Berg J, Dangas GD. Antithrombotic therapy after transcatheter aortic valve replacement. Circ Cardiovasc Interv. 2019;12:e007411.

    Article  Google Scholar 

  7. Chakravarty T, Sondergaard L, Friedman J, De Backer O, Berman D, Kofoed KF, et al. Subclinical leaflet thrombosis in surgical and transcatheter bioprosthetic aortic valves: an observational study. Lancet. 2017;389:2383–92.

    Article  Google Scholar 

  8. Mastoris I, Schoos MM, Dangas GD, Mehran R. Stroke after transcatheter aortic valve replacement: incidence, risk factors, prognosis, and preventive strategies. Clin Cardiol. 2014;37:756–64.

    Article  Google Scholar 

  9. Verdoia M, Barbieri L, Nardin M, Suryapranata H, De Luca G. Dual versus single antiplatelet regimen with or without anticoagulation in transcatheter aortic valve replacement: indirect comparison and meta-analysis. Rev Esp Cardiol (Engl Ed). 2018;71:257–66.

    Article  Google Scholar 

  10. Ahmad Y, Demir O, Rajkumar C, Howard JP, Shun-Shin M, Cook C, et al. Optimal antiplatelet strategy after transcatheter aortic valve implantation: a meta-analysis. Open Heart. 2018;5:e000748.

    Article  Google Scholar 

  11. Zuo W, Yang M, He Y, Hao C, Chen L, Ma G. Single or dual antiplatelet therapy after transcatheter aortic valve replacement: an updated systemic review and meta-analysis. J Thorac Dis. 2019;11:959–68.

    Article  Google Scholar 

  12. Alrifai A, Soud M, Kabach A, Jobanputra Y, Masrani A, El Dassouki S, et al. Dual antiplatelet therapy versus single antiplatelet therapy after transaortic valve replacement: meta-analysis. Cardiovasc Revasc Med. 2018;19:47–52.

    Article  Google Scholar 

  13. Raheja H, Garg A, Goel S, Banerjee K, Hollander G, Shani J, et al. Comparison of single versus dual antiplatelet therapy after TAVR: a systematic review and meta-analysis. Catheter Cardiovasc Interv. 2018;92:783–91.

    Article  Google Scholar 

  14. Sherwood MW, Vemulapalli S, Harrison JK, Dai D, Vora AN, Mack MJ, et al. Variation in post-TAVR antiplatelet therapy utilization and associated outcomes: insights from the STS/ACC TVT registry. Am Heart J. 2018;204:9–16.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Cardiothoracic Services, Freeman Hospital, Newcastle-upon-Tyne, NE7 7DN, UK

    Mohammad Alkhalil, Richard Edwards, Azfar Zaman & Rajiv Das

  2. Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA

    Rishi Puri & Ankur Kalra

  3. Newcastle University, Newcastle-upon-Tyne, UK

    Azfar Zaman

  4. Northumbria University, Newcastle upon Tyne, UK

    Rajiv Das

Authors
  1. Mohammad Alkhalil
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  2. Richard Edwards
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  3. Rishi Puri
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  4. Ankur Kalra
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  5. Azfar Zaman
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  6. Rajiv Das
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Contributions

Conceptualization, investigation, and methodology MA, RP, AK, RD; project administration, data curation and software MA; formal analysis MA; writing original draft and preparation MA; All authors were involved in editing and critically evaluating the manuscript.

Corresponding author

Correspondence to Mohammad Alkhalil.

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The authors declare that they have no conflicts of interest.

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This article does not contain any studies with human participants or animals performed by any of the authors (meta-analysis).

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N/A (meta-analysis).

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Alkhalil, M., Edwards, R., Puri, R. et al. Aspirin Versus Dual Antiplatelet Therapy in Patients Undergoing Trans-Catheter Aortic Valve Implantation, Updated Meta-Analysis. Cardiovasc Drugs Ther 36, 279–283 (2022). https://doi.org/10.1007/s10557-021-07146-6

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  • DOI: https://doi.org/10.1007/s10557-021-07146-6

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