Comparing Dual Vs. Single Antiplatelet Therapy After Transcatheter Aortic Valve Implantation

Objective:Currently,dual antiplatelet therapy is routine treatment after transcatheter aortic valve implantation(TAVI),but many studies have confirmed that the efficacy of single antiplatelet therapy(SAPT)is not worse than that of dual antiplatelet therapy(DAPT).The purpose of this study is compared the efficacy and safety of DAPT with SAPT after TAVI.Methods:we using key words and Mesh terms search the Cochrane Central Register of Controlled trials,Pub Med,Embase,Web of Sciences,CNKI and Wan Fang for randomized control trials(RCT)comparing DAPT with SAPT after TAVI from January 2002 to December 2020.The quality of the included studies are assessed and the included studies are analyzed by Review Manager 5.4 software provided by the Cochrane Collaboration.Results:4 randomized controlled clinical studies were included with a total of 1086patients(545 in the DAPT group and 541 in the SAPT group).The results showed that SAPT could reduce the risk of bleeding more than 90 days after TAVI(OR=1.86,95%CI 1.31-2.04,P=0.0005,I~2=0%)and the risk of severe and life-threatening bleeding(OR=2.34,95%CI 1.31-3.85,P=0.0008,I~2=0%).SAPT did not increase the risk of stroke more than 90 days after TAVI(OR=1.07,95%CI 0.59-1.93,P=0.82,I~2=0%),the risk of all-cause death(OR=0.99,95%CI 0.60-1.63,P=0.96,I~2=0%),risk of cardiovascular related death(OR=0.92,95%CI 0.45-1.88,P=0.82,I~2=0%),and risk of myocardial infarction(OR=2.02,95%CI 0.71-5.73,P=0.19,I~2=0%).DAPT increased the risk of severe and life-threatening bleeding within 30 days after TAVI(OR=2.63,95%CI 1.07-6.38,P=0.03,I~2=0%).But did not increase the risk of all-cause death(OR=1.22,95%CI 0.48-3.12,P=0.68,I~2=0%),cardiovascular related death(OR=0.99;95%CI 0.17-5.83,P=0.99),or stroke(OR=0.94,95%CI 0.27-3.23,P=0.92,I~2=0%).Conclusion:SAPT can reduce the risk of bleeding after TAVI,and does not increase the risk of thromboembolism and death.