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Meta-Analysis of Aspirin Monotherapy Versus Dual Antiplatelet Therapy After Transcatheter Aortic Valve Implantation

Published:September 19, 2020DOI:https://doi.org/10.1016/j.amjcard.2020.09.024
      Transcatheter Aortic Valve Implantation (TAVI) is increasingly being performed in patients with severe aortic stenosis.
      • Otto CM
      • Kumbhani DJ
      • Alexander KP
      • Calhoon JH
      • Desai MY
      • Kaul S
      • Lee JC
      • Ruiz CE
      • Vassileva CM
      2017 ACC expert consensus decision pathway for transcatheter aortic valve replacement in the management of adults with aortic stenosis.
      The current American guidelines recommend dual antiplatelet therapy (DAPT) for the first 3 to 6 months after TAVI in patients who are not on anticoagulation.
      • Otto CM
      • Kumbhani DJ
      • Alexander KP
      • Calhoon JH
      • Desai MY
      • Kaul S
      • Lee JC
      • Ruiz CE
      • Vassileva CM
      2017 ACC expert consensus decision pathway for transcatheter aortic valve replacement in the management of adults with aortic stenosis.
      These recommendations have been established based on experts’ opinions due to the lack of clinical trials investigating the optimal antithrombotic therapy in this population. More recently, multiple studies have questioned the benefit of DAPT in reducing thromboembolic outcomes and revealed high bleeding events in patients who received DAPT after TAVI compared with aspirin monotherapy.
      • Brouwer J
      • Nijenhuis VJ
      • Delewi R
      • Hermanides RS
      • Holvoet W
      • Dubois CLF
      • Frambach P
      • De Bruyne B
      • van Houwelingen GK
      • Van Der Heyden JAS
      • Toušek 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 DRPP
      • Swaans MJ
      • Rensing BJWM
      • 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. [published online ahead of print, 2020 Aug 30].
      Cardiology ACo
      SAT-TAVI (Single Antiplatelet Therapy for TAVI) study: a randomized study comparing double to single antiplatelet therapy for transcatheter aortic valve implantation.
      • Rodés-Cabau J
      • Masson J-B
      • Welsh RC
      • del Blanco BG
      • Pelletier M
      • Webb JG
      • Al-Qoofi F
      • Généreux P
      • Maluenda G
      • Thoenes M
      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.
      • Ussia GP
      • Scarabelli M
      • Mulè M
      • Barbanti M
      • Sarkar K
      • Cammalleri V
      • Immè S
      • Aruta P
      • Pistritto AM
      • Gulino S
      Dual antiplatelet therapy versus aspirin alone in patients undergoing transcatheter aortic valve implantation.
      Therefore, we conducted a meta-analysis of all randomized controlled trials (RCTs) to assess the safety and efficacy of DAPT versus aspirin monotherapy after TAVI.
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      References

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        • Kumbhani DJ
        • Alexander KP
        • Calhoon JH
        • Desai MY
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        • Lee JC
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        • Chan Pin Yin DRPP
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        • Rensing BJWM
        • van ’t Hof AWJ
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        • ten Berg JM
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        • Maluenda G
        • Thoenes M
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