Comparing Single- and Dual Antiplatelet Therapies Following Transcatheter Aortic Valve Implantation

Abstract Background Transcatheter aortic valve implantation has been an established treatment in patients with symptomatic severe aortic stenosis. However, the postoperative antiplatelet regimen after transcatheter aortic valve implantation was not established certainly. The aim of this meta-analysis is to compare the safety and efficacy of single- (SAPT) and dual-antiplatelet therapies (DAPT) in patients undergoing transcatheter aortic valve implantation. Methods Eligible randomized controlled trials and cohort studies published before February 2021 were retrieved from PubMed, Embase, and the Cochrane Library. We calculated odds ratios with 95% confidence intervals. Results Nine articles, involving 19,277 patients, met the selection criteria. In the short-term outcome, compared with SAPT, DAPT was associated with a significantly higher rate of bleeding (odds ratios, 95% confidence intervals: 3.00, 1.67–5.38) and showed no significant differences in thrombotic events (odds ratios, 95% confidence intervals: 1.25, 0.74–2.11) and all-cause mortality (odds ratios, 95% confidence intervals: 0.84; 0.42–1.69). In the long-term outcome, DAPT was associated with a significantly higher bleeding rate (odds ratios, 95% confidence intervals: 1.85, 1.24–2.78) and showed no differences in thrombotic events (odds ratios, 95% confidence intervals: 1.13, 0.86–1.48) and all-cause mortality (odds ratios, 95% confidence intervals: 1.12, 0.95–1.32). Our trial sequential analysis confirmed DAPT didn’t confer any benefit for reducing all-cause mortality and thrombotic events, and carried a higher risk of bleeding than SAPT. Conclusions SAPT should be a sufficient antiplatelet strategy in post- transcatheter aortic valve implantation patients without indications for oral anticoagulation medication, especially in the long-term follow-up period.