Key result
Aspirin-only therapy following transcatheter aortic valve implantation showed no significant difference in 30-day net adverse clinical and cerebral events compared to dual antiplatelet therapy (OR 0.83).
Why the study?
Does aspirin-only therapy reduce net adverse clinical and cerebral events compared to dual antiplatelet therapy in patients following TAVI?
Meta-Analysis (n=672)
Yes
Does aspirin-only therapy reduce net adverse clinical and cerebral events compared to dual antiplatelet therapy in patients following TAVI?
Odds Ratio: 0.83 (95% CI 0.48–1.43)
Absolute Event Rate: 13% vs 15%
p-value: p=0.50
Aspirin alone following TAVI results in similar 30-day net adverse clinical and cerebral events compared to dual antiplatelet therapy, with a trend toward less life-threatening and major bleeding.
Aspirin monotherapy yields similar 30-day NACE to DAPT post-TAVI; confirms safety of single-agent therapy while supporting bleeding-risk reduction.
OBJECTIVE: There is limited evidence to support decision making on antiplatelet therapy following transcatheter aortic valve implantation (TAVI). Our aim was to assess the efficacy and safety of aspirin-only (ASA) versus dual antiplatelet therapy (DAPT) following TAVI. METHODS: We performed a systematic review and pooled analysis of individual patient data from 672 participants comparing single versus DAPT following TAVI. Primary endpoint was defined as the composite of net adverse clinical and cerebral events (NACE) at 1 month, including all-cause mortality, acute coronary syndrome (ACS), stroke, life-threatening and major bleeding. RESULTS: At 30 days a NACE rate of 13% was observed in the ASA-only and in 15% of the DAPT group (OR 0.83, 95% CI 0.48 to 1.43, p=0.50). A tendency towards less life-threatening and major bleeding was observed in patients treated with ASA (OR 0.56, 95% CI 0.28 to 1.11, p=0.09). Also, ASA was not associated with an increased all-cause mortality (OR 0.91, 95% CI 0.36 to 2.27, p=0.83), ACS (OR 0.5, 95% CI 0.05 to 5.51, p=0.57) or stroke (OR 1.21; 95% CI 0.36 to 4.03, p=0.75). CONCLUSIONS: No difference in 30-day NACE rate was observed between ASA-only or DAPT following TAVI. Moreover, a trend towards less life-threatening and major bleeding was observed in favour of ASA. Consequently the additive value of clopidogrel warrants further investigation.
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Hassell et al. (2015) conducted a meta-analysis in Severe symptomatic aortic stenosis treated with TAVI (n=672). Aspirin-only therapy vs. Dual antiplatelet therapy (DAPT) was evaluated on Net adverse clinical and cerebral events (NACE) at 1 month (OR 0.83, 95% CI 0.48-1.43, p=0.50). Aspirin-only therapy following transcatheter aortic valve implantation showed no significant difference in 30-day net adverse clinical and cerebral events compared to dual antiplatelet therapy (OR 0.83).
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