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Optimal antiplatelet strategy after transcatheter aortic valve implantation: a meta-analysis

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Title: Optimal antiplatelet strategy after transcatheter aortic valve implantation: a meta-analysis
Authors: Ahmad, Y
Demir, O
Rajkumar, CA
Howard, J
Shun-Shin, M
Cook, C
Petraco, R
Jabbour, R
Arnold, A
Frame, A
Sutaria, N
Ariff, B
Kanaganayagam, G
Francis, D
Mayet, J
Mikhail, G
Malik, I
Sen, S
Item Type: Journal Article
Abstract: Objective International guidelines recommend the use of dual antiplatelet therapy (DAPT) after transcatheter aortic valve implantation (TAVI). The recommended duration of DAPT varies between guidelines. In this two-part study, we (1) performed a structured survey of 45 TAVI centres from around the world to determine if there is consensus among clinicians regarding antiplatelet therapy after TAVI; and then (2) performed a systematic review of all suitable studies (randomised controlled trials (RCTs) and registries) to determine if aspirin monotherapy can be used instead of DAPT. Methods A structured electronic survey regarding antiplatelet use after TAVI was completed by 45 TAVI centres across Europe, Australasia and the USA. A systematic review of TAVI RCTs and registries was then performed comparing DAPT duration and incidence of stroke, bleeding and death. A variance weighted least squared metaregression was then performed to determine the relationship of antiplatelet therapy and adverse events. Results 82.2% of centres routinely used DAPT after TAVI. Median duration was 3 months. 13.3% based their practice on guidelines. 11 781 patients (26 studies) were eligible for the metaregression. There was no benefit of DAPT over aspirin monotherapy for stroke (P=0.49), death (P=0.72) or bleeding (P=0.91). Discussion Aspirin monotherapy appears to be as safe and effective as DAPT after TAVI.
Issue Date: 26-Jan-2018
Date of Acceptance: 29-Dec-2017
URI: http://hdl.handle.net/10044/1/55630
DOI: https://dx.doi.org/10.1136/openhrt-2017-000748
ISSN: 2053-3624
Publisher: BMJ Publishing Group
Journal / Book Title: Open Heart
Volume: 5
Copyright Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Sponsor/Funder: Wellcome Trust
Funder's Grant Number: PS3162_WHCP
Publication Status: Published
Article Number: e000748
Appears in Collections:Institute of Clinical Sciences