Meta-Analysis Of Efficacy And Safety Of Mono-Antiplatelet And Dual-Antiplatelet Therapy After Transcatheter Aortic Valve Replacement

Objective: To investigate the efficacy and safety of mono-antiplatelet and dual-antiplatelet therapy after transcatheter aortic valve replacementMethods: A computerized search of PubMed,Embase,The Cochrane Library,Chinese CNKI,CBM,Wanfang and Weipu Chinese Sci-tech Journals database for anti-thrombotic therapy for patients receiving TA aspirinumab and aspirin plus clopidogrel double antibody after TAVR.Efficacy events include transient ischemic attack,stroke,myocardial infarction,all-cause death,vascular complications,etc.Safety events include major bleeding and life-threatening major bleeding.Statistical analysis was performed using Review Manager 5.3 software,and the odds ratio(OR)and 95% confidence interval(CI)were calculated to represent the summary effect.For example,P<0.05 after the combination indicates that the difference is statistically significant.Results: Four cohort studies were included,three RCTs,and antithrombotic time after TAVR ranged from 30 days to 1 year.The results showed that MAPT had a lower risk of all-cause mortality compared with DAPT in the antithrombotic therapy within 30 days after TAVR(OR: 0.45;95% CI: 0.31-0.65;P < 0.001),increased DAPT Vascular complications(OR:0.26;95%CI:0.16—0.42;P<0.00001)and the risk of major bleeding,life-threatening major bleeding(OR: 0.38;95% CI: 0.21-0.7;P = 0.002),stroke,transient There was no significant difference in the incidence of ischemic attack(OR: 0.75;95% CI: 0.45-1.27;P=0.29)and myocardial infarction(OR: 0.74;95% CI: 0.21-2.64;P = 0.64).Subgroup analysis based on antithrombotic time showed that the risk of DAPT was greater than that of MAPT major bleeding and life-threatening major bleeding after antithrombotic therapy for >1 month after TAVR(OR: 0.41;95% CI: 0.22-0.74;P=0.003),all-cause death(OR: 0.93;95% CI:0.73-1.19;P=0.58),There was no significant difference in the stroke,and transient ischemic attack(OR: 0.57;95% CI: 0.24-1.37;P= 0.21).Conclusions: In antithrombotic therapy within 30 days after TAVR,MAPT is superior to DAPT in terms of all-cause mortality,vascular complications,andbleeding events,in terms of systemic embolic events(stroke,transient ischemic attack,myocardial infarction)There was no significant difference between the two;in the antithrombotic therapy >1 month after TAVR,the risk of DAPT was increased compared with MAPT,.