Key result
Single antiplatelet therapy shows no difference in stroke versus DAPT post-TAVR, trending toward less bleeding.
Why the study?
Antiplatelet therapy for post-TAVR stroke prevention remains ambiguous, with DAPT routinely initiated despite limited data comparing its effectiveness and bleeding safety against SAPT.
Does dual antiplatelet therapy compared to single antiplatelet therapy improve stroke prevention or affect bleeding safety in patients post-TAVR?
Meta-Analysis (n=421)
Does dual antiplatelet therapy compared to single antiplatelet therapy improve stroke prevention or affect bleeding safety in patients post-TAVR?
Effect estimate: OR 2.56 (95% CI 0.79-8.30)
Absolute Event Rate: 4.7% vs 1.9%
p-value: p=0.12
In post-TAVR patients, single antiplatelet therapy is preferable to dual antiplatelet therapy as it offers comparable stroke prevention with significantly lower risks of major bleeding and all-cause mortality.
Supports single antiplatelet therapy post-TAVR; extends meta-analysis evidence for comparable stroke prevention with lower bleeding.
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.
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Yap et al. (2021) conducted a meta-analysis in Post-Transcatheter Aortic Valve Replacement (TAVR) (n=421). Single antiplatelet therapy (SAPT) vs. Dual antiplatelet therapy (DAPT) was evaluated on Incidence of stroke (OR 2.56, 95% CI 0.79-8.30, p=0.12). Single antiplatelet therapy resulted in no significant difference in stroke incidence compared to dual antiplatelet therapy post-TAVR (OR 2.56), with a trend toward lower bleeding complications.
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