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Single versus dual anti-platelet therapy post transcatheter aortic valve implantation: a meta-analysis of randomized controlled trials

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Abstract

The purpose of this systematic review and meta-analysis was to assess the 30-days safety (bleeding and vascular events) and efficacy (reduction in major stroke, myocardial infarction and mortality) of single anti-platelet (SAPT) versus dual anti-platelet (DAPT) after transcatheter aortic valve implantation (TAVI). We used a meta-analytic method with Mantel–Haenszel methods to calculate the odds ratio (OR) and 95% confidence interval (CI). Only randomized clinical trials that compared 30-days safety and efficacy based on Valve Academic Research Consortium criteria were included. Studies that included patients on anticoagulants were excluded. Our analysis included three studies with a total of 421 patients (210 SAPT and 211 DAPT). Life-threatening and major bleeding as well as major vascular complications was similar between SAPT and DAPT. Similarly, major stroke, myocardial infarction and mortality was also comparable between the two groups. The combined outcomes of 30-day mortality, life-threatening and major bleeding showed tendency toward lower event rates in SAPT compared to DAPT (9.5 vs. 15.6%, OR 0.57; 95% CI 0.31–1.03, p = 0.06). In conclusion, SAPT provided similar safety without adding incremental efficacy compared to DAPT but showed tendency of lower combined endpoints of 30-day mortality, life-threatening and major bleeding.

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Authors and Affiliations

  1. Division of Cardiovascular Disease, Department of Internal Medicine, Harper hospital, Wayne State University, Detroit, USA

    Tomo Ando & Luis Afonso

  2. Division of Cardiovascular Surgery, Department of Surgery, Shizuoka Medical Center, Shizuoka, Japan

    Hisato Takagi

  3. Division of Cardiovascular Disease, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA

    Alexandros Briasoulis

  4. Division of Cardiology, Detroit Medical Center, 3990, John R, Detroit, MI, 48201, USA

    Tomo Ando

Authors
  1. Tomo Ando
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  2. Hisato Takagi
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  3. Alexandros Briasoulis
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  4. Luis Afonso
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Correspondence to Tomo Ando.

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This was a systematic review of the previously published original articles and therefore in accordance with the ethical standards.

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This was a systematic review of the previously published articles and therefore did not require approval from institutional board review.

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Supplementary material 1—Flow chart of study selection (TIFF 26369 KB)

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Ando, T., Takagi, H., Briasoulis, A. et al. Single versus dual anti-platelet therapy post transcatheter aortic valve implantation: a meta-analysis of randomized controlled trials. J Thromb Thrombolysis 44, 448–456 (2017). https://doi.org/10.1007/s11239-017-1550-9

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  • DOI: https://doi.org/10.1007/s11239-017-1550-9

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