Single- or dual-antiplatelet therapy after transcatheter aortic valve replacement

Abstract

Background The evidence related to bleeding and thromboembolic events after transcatheter aortic valve replacement (TAVR) compared single antiplatelet therapy (SAPT) with dual antiplatelet therapy (DAPT) treatment are inconsistent. Moreover, there are some limitations such as small sample size and the risk of bias in existing studies. We will conduct a comprehensive systematic review and meta-analysis to explore the safety and efficacy of SAPT or DAPT after TAVR. Methods A comprehensive literature search of PubMed, EMBASE, The Cochrane Library, Cochrane Central Register of Controlled Trials will be searched to retrieve studies involving SAPT versus DAPT after TAVR. Two investigators will independently select studies, extract data, and assess the quality of the included study. Any disagreement will be resolved by the third investigator. The study will use a random-effects model to pool the results of all studies and use the relative risk and 95% confidence intervals to summarize individual trial outcomes and estimate pooled effect. The study will use the Grading of Recommendations Assessment, Development, and Evaluation to assess the certainty of evidence. Results This study will provide high-quality evidence for treatment of TAVR in terms of effectiveness and safety. Conclusion This systematic review aims to provide evidence for treatment of TAVR in different antiplatelet therapies. Registration The systematic review and meta-analysis is registered in the OSF REGISTRIES (10.17605/OSF.IO/Q42TE) international prospective register.

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

“…7 Several studies have explored the use of antiplatelet therapy after TAVR. The results of several recent metaanalyses [29][30][31][32][33][34] have shown that the postoperative use of DAPT increases the risk of bleeding in patients compared with non-DAPT. The study by Kille et al 35 found that low platelet reactivity during clopidogrel treatment and the use of oral anticoagulation were the strongest predictors of perioperative bleeding events, which supports the recommendation that DAPT should not be routinely used after TAVR.…”