Meta-Analysis Comparing Dual Antiplatelet Therapy Versus Single Antiplatelet Therapy Following Transcatheter Aortic Valve Implantation

The present American College of Cardiology/American Heart Association guidelines (Grade IIb, level of evidence C) recommend dual antiplatelet therapy (DAPT) with aspirin and clopidogrel for 6 months followed by lifelong aspirin after transcathter aortic valve implantation (TAVI). However, studies that have compared DAPT to single antiplatelet therapy (SAPT) after TAVI have questioned this recommendation as DAPT has been associated with more bleeding events compared with SAPT. We performed a meta-analysis of all the trials that compared DAPT to SAPT in patients who underwent TAVI. Three randomized trials and 4 nonrandomized studies were included. The primary endpoint was the rate of ischemic stroke. Secondary end points were the rates of myocardial infarction, life threatening bleeding (LTB), significant bleeding (LTB and major bleeding), and death. The Mantel-Haenszel random effects model was used to calculate the combined odds ratios (OR) and 95% confidence intervals (CI) for outcomes at 30days and up to 6 to 12months follow-up. The LTB (OR 2.73, 95% CI 1.31 to 5.69, p = 0.007) and significant bleeding rates (OR 2.76, 95% CI 1.57 to 4.85, p = 0.0004) were significantly higher in DAPT arm at 30days. Significant bleeding (OR 2.24, 95% CI 1.33 to 3.79, p = 0.002) was still significantly higher in the DAPT arm but there was only a nonsignificant trend toward higher LTB (OR 1.93 95% CI 0.61 to 6.03, p = 0.26) at 6 to 12 month follow up. There was no difference in mortality, ischemic stroke and myocardial infarction at 30days or 6 to 12month follow up. In conclusion, our meta-analysis shows that DAPT after TAVI does not confer any additional benefit over SAPT in TAVI.