Abstract 10242: Single versus Dual Antiplatelet Post Transcatheter Aortic Valve Replacement: An Updated Meta-Analysis

Abstract

Introduction: Perioperative use of dual antiplatelet therapy (DAPT) after transcatheter aortic valve replacement (TAVR) remains controversial. This meta-analysis compares the safety and efficacy of single anti-antiplatelet therapy (SAPT) versus DAPT after TAVR in patients with no indications for long-term anticoagulation. Hypothesis: The use of SAPT is safe and efficacious in TAVR patients. Methods: Electronic databases were queried for randomized controlled trials (RCTs) and observational studies matching the inclusion criteria. The safety endpoints included bleeding and major vascular complications. The efficacy outcomes included myocardial infarction (MI), stroke, short and long-term all-cause mortality. The ratio risk ratio (RR) with 95% confidence interval (CI) was computed using a random-effect model. Results: A total of 4 RCTs and 2 observational studies (n=1,417) were included in the final analysis. There were decreased rates of bleeding (life-threatening or major) (RR: 0.44; CI: 0.31-0.63) with aspirin only therapy. However, there was no difference of MI (RR: 0.73; CI: 0.28-1.87), stroke (RR: 0.92; CI: 0.55-1.54), major vascular complications (RR: 0.61; CI: 0.35-1.07), short-term mortality (>30 days) (RR: 0.82; CI: 0.45-1.49), and long-term mortality (>30 days) (RR: 1.13; CI: 0.73-1.76). Conclusions: This analysis showed lower rates of bleeding and composite of bleeding/thromboembolic events with aspirin only compared to dual antiplatelet amongst patients that underwent TAVR for aortic stenosis.