Non-dual antiplatelet therapy versus dual antiplatelet therapy prior to transcatheter aortic valve replacement: A systematic review and meta-analysis

Abstract

Transcatheter aortic valve replacement (TAVR) is an interventional procedure performed in patients with severe aortic stenosis and often required perioperative antiplatelet therapy. Most previous studies have focused on antiplatelet therapy following TAVR. However, few studies have investigated the prognostic effect of preoperative antiplatelet therapy in patients undergoing TAVR. This study aimed to compare the efficacy and safety of non-dual antiplatelet therapy (non-DAPT) and dual antiplatelet therapy (DAPT) before TAVR. We performed a systematic search of Embase, PubMed, and web of science until February 2023. Studies were eligible if they compared non-DAPT (SAPT or no antiplatelet therapy) with DAPT in patients before TAVR. A total of five studies, including 2,329 patients, met the inclusion criteria and were included in the meta-analysis. Preoperative non-DAPT significantly decreased minor bleeding events compared with preoperative DAPT (OR 0.58; 95% CI: 0.44 - 0.76). There were no significant differences in the incidence of other bleeding events, transfusions, stroke, myocardial infarction, or all-cause death. Preoperative SAPT significantly decreased the incidence of major bleeding compared with DAPT (OR 0.14; 95% CI: 0.04 - 0.48). Preoperative non-DAPT significantly reduced minor bleeding events in patients undergoing TAVR, without increasing the risk of stroke and myocardial infarction.