Duration of Antiplatelet Therapy Following Transcatheter Aortic Valve Replacement: Systematic Review and Network Meta‐Analysis

Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease

Tomo Ando¹  Hisato Takagi²  Masao Iwagami³  Toshiki Kuno⁴  Yujiro Yokoyama⁵  Makoto Mori⁶  Alexandros Briasoulis⁷  Sripal Bangalore⁸ 

[1] Department of Cardiology Kawasaki Saiwai Hospital Kawasaki Japan;Department of Cardiovascular Surgery Shizuoka Medical Center Shizuoka Japan;Department of Health Services Research University of Tsukuba Japan;Department of Medicine Icahn School of Medicine at Mount SinaiMount Sinai Beth Israel New York NY;Department of Surgery St. Luke's University Health Network Bethlehem PA;Division of Cardiac Surgery Yale School of Medicine New Haven CT;Division of Cardiology, Heart Failure and Transplantation University of Iowa Iowa City IA;Division of Cardiovascular Medicine New York University School of Medicine New York NY;

关键词: aspirin;    clopidogrel;    dual antiplatelet therapy;    transcatheter aortic valve replacement;   

DOI  :  10.1161/JAHA.120.019490

来源: DOAJ

【 摘 要 】

Background Although current guidelines recommend dual antiplatelet therapy (DAPT) for 3 to 6 months following transcatheter aortic valve replacement (TAVR), there are no studies directly comparing outcomes of different durations of DAPT following TAVR. Methods and Results PubMed, EMBASE, and Cochrane Database were searched through November 2020 to identify clinical studies that investigated single antiplatelet therapy versus DAPT use following TAVR. Studies using oral anticoagulants and antiplatelet therapy concomitantly were excluded. The DAPT group was subdivided by the duration of DAPT. We extracted the risk ratios (RRs) of major or life‐threatening bleeding, stroke, and all‐cause mortality. Four randomized controlled trials, 2 propensity‐score matched studies, and 1 observational study were identified, yielding a total of 2498 patients who underwent TAVR assigned to the single antiplatelet therapy group (n=1249), 3‐month DAPT group (n=485), or 6‐month DAPT group (n=764). Pooled analyses demonstrated that when compared with the single antiplatelet therapy group, the rates of major or life‐threatening bleeding were significantly higher in the 3‐ and 6‐month DAPT groups (RR [95% CI]=2.13 [1.33–3.40], P=0.016; RR [95% CI]=2.54 [1.49–4.33], P=0.007, respectively) with no difference between the 3‐month DAPT versus 6‐month DAPT groups. The rates of stroke and all‐cause mortality were similar among the 3 groups. Conclusions In this network meta‐analysis of antiplatelet therapy following TAVR, single antiplatelet therapy with aspirin had lower bleeding without increasing stroke or death when compared with either 3‐ or 6‐month DAPT.

【 授权许可】

Unknown