Author + information
Dual antiplatelet therapy (DAPT) could add the benefit of reducing the ischemic complications and valve thrombosis in patients who underwent TAVR. There is a lack of data disclosing if those benefits outweigh the risks of increased bleeding risk. We evaluated all clinical data that compared DAPT to mono antiplatelet therapy (MAPT) for patients who underwent TAVR.
Pub Med and Cochrane databases were systematically searched for clinical studies comparing the short-term outcomes of DAPT and MAPT for patients who underwent TAVR. The primary endpoint was any bleeding at 30 days post-procedure. Secondary endpoints included AMI, stroke and all-cause death. We used fixed (I2 < 55%) otherwise random effect analysis using the Cochrane Handbook of Systematic Reviews.
A total of 6 studies (3 RCT’s and 3 observational/registry) provided a total of 1402 patients (690 = DAPT and 712 = MAPT group). Overall, there was a significant less bleeding events in the MAPT group compared to DAPT (13% vs. 25%, p < 001), although subanalysis using only RCT’s only showed a trend (p=0.09). There was no significant difference in regards stroke between DAPT and MAPT (2% vs. 2%, p>0.05), AMI (1% vs. 0.7%, p>0.05) and all-cause death (5% vs. 4%, P>0.05).
Our analysis suggests that DAPT is not associated with any significant better clinical outcome compared to MAPT but with significant increased bleeding risks in the overall analysis but only a trend in the RCT’s subanalysis. In-deep analysis with further RTC’s should be pursued in order to investigate the short and long-term outcomes.