Vol. 49 | No. 2 | July-December 2021 Back

Open Access

Dual Antiplatelet Versus Single Antiplatelet in Post– Transcatheter Aortic Valve Implantation/Transcatheter Aortic Valve Replacement for Stroke Prevention: A Systematic Review and Meta-analysis

Ralph Yap, Douglas Bailon, Abigail Louise Te-Rosano
Dec 2021 DOI 10.69944/pjc.7336a89120

Abstract

BACKGROUND: There is ambiguity on antiplatelet therapy for post–transcatheter aortic  valve replacement (TAVR) patients for stroke prevention, but dual antiplatelet therapy (DAPT) is  routinely started despite lack of data on effectiveness and bleeding safety of DAPT versus single  antiplatelet therapy (SAPT). This study aims to determine the effectiveness of DAPT versus SAPT  in stroke prevention and assess bleeding safety. 

METHODS: A systematic search was done for randomized clinical trials involving DAPT and  SAPT in patients who underwent TAVR. The primary outcome was stroke after 1 year of either  DAPT and SAPT and life-threatening bleeding. Secondary end points included all-cause mortality.  Trials were identified through systematic searches on the following databases (November 2019):  Cochrane, MEDLINE, and Google Scholar and ClinicalTrials.gov and World Health Organization  International Clinical Trials Registry Platform. Risk ratio was used for dichotomous outcomes.  Heterogeneity among the studies for the meta-analysis was detected using a χ2 test (0.01 level of  significance). Risk-of-bias assessment was done. 

RESULTS: There is a lower incidence of stroke in patients on DAPT, but with a higher incidence  of life-threatening bleeding and major bleeding. There is also a lower incidence of all-cause  mortality in SAPT. The statistical power of this meta-analysis is low due to small population size. 

CONCLUSION: Single antiplatelet therapy is comparable to DAPT in preventing stroke with the  added benefit of a lower incidence of life-threatening and major bleeding and a lower incidence  of all-cause mortality. 

KEYWORDS: antiplatelet therapy, bleeding, dual antiplatelet therapy, single antiplatelet therapy,  mortality, myocardial infarction, stroke, transcatheter aortic valve replacement, transcatheter  aortic valve implantation

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