Single or dual antiplatelet therapy after transcatheter aortic valve replacement: an updated systemic review and meta-analysis

Background: Although current guidelines recommend dual antiplatelet therapy (DAPT) with aspirin and clopidogrel as an antiplatelet strategy after transcatheter aortic valve replacement (TAVR), it is not based on clinical evidence. Here we aim to review updated evidence systemically and assess safety and efficacy of the two antiplatelet regimens. Methods: PubMed, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) were searched to retrieve studies involving single antiplatelet therapy (SAPT) versus DAPT after TAVR. We screened the records and extracted the data from publications independently. Relative risks (RRs) and the corresponding 95% confidence intervals (CIs) were used to compare the efficacy and safety of SAPT with that of DAPT in fixed-effects model with Mantel-Haenszel method. The quality of evidence was assessed by the scoring system, GRADE (Grading of Recommendations Assessment, Development, and Evaluation). Results: A total of 2,489 patients from 8 studies were enrolled in this meta-analysis. Compared with DAPT, SAPT was associated with a lower all-cause mortality (RR=0.57; 95% CI, 0.36-0.89; P=0.014) and major/life-threatening bleeding (RR=0.62; 95% CI, 0.50-0.76; P=0.000) in 30 days. Furthermore, there was no significant difference found between SAPT and DAPT group in terms of 30-day stroke (RR=0.85; 95% CI, 0.45-1.63; P=0.631) and death beyond 3 months (RR=0.96; 95% CI, 0.81-1.15; P=0.664). Conclusions: This meta-analysis suggests that compared with DAPT, SAPT after TAVR is more likely to lead to a decline of 30-day mortality along with the reduced risk of bleeding and no increased risk of stroke. However, more clinical data and evidence from randomized controlled trials are warranted to clarify the optimal post-TAVR antiplatelet strategy.