Meta-Analysis Comparing Single Versus Dual Antiplatelet Therapy Following Transcatheter Aortic Valve Implantation

Area of Science:

• Cardiology
• Interventional Cardiology
• Thrombosis Research

Background:

• Transcatheter aortic valve implantation (TAVI) is a growing procedure for aortic stenosis.
• Optimal antithrombotic therapy post-TAVI remains debated, with current guidelines often recommending dual antiplatelet therapy (DAPT).
• Concerns exist regarding the balance between preventing thrombotic events and increasing bleeding risk with DAPT.

Purpose of the Study:

• To compare the efficacy and safety of DAPT versus single antiplatelet therapy (SAPT) following TAVI.
• To evaluate the impact of DAPT versus SAPT on ischemic events, bleeding events, and mortality.
• To inform optimal antithrombotic strategies after TAVI procedures.

Main Methods:

• Patient-level meta-analysis of three randomized controlled trials comparing DAPT and SAPT post-TAVI.
• Inclusion of 421 patients (210 DAPT, 211 SAPT).
• Primary endpoint: composite of death, major/life-threatening bleeding, and major vascular complications at 30 days, adjudicated by Valve Academic Research Consortium 2 criteria.

Main Results:

• The 30-day composite primary endpoint was significantly higher in the DAPT group (17.6%) compared to the SAPT group (10.9%).
• Major or life-threatening bleeding events were significantly increased with DAPT (11.4%) versus SAPT (5.2%).
• No significant differences were observed between DAPT and SAPT for death, global ischemic events, or stroke.

Conclusions:

• DAPT following TAVI is associated with a higher rate of major adverse events, primarily driven by increased bleeding risk.
• DAPT did not demonstrate a significant benefit in reducing ischemic events compared to SAPT after TAVI.
• Current recommendations for DAPT post-TAVI may need reevaluation based on these findings, favoring SAPT in many cases.