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Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation
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Comparing Single- and Dual-Antiplatelet Therapies After Transcatheter Aortic Valve Implantation

Hao-Tse Chiu1, Hong-Jie Jhou2, Po-Huang Chen3

  • 1Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China.

The Annals of Thoracic Surgery
|October 29, 2021
PubMed

Insights

Single-antiplatelet therapy (SAPT) is sufficient post-transcatheter aortic valve implantation, reducing bleeding risk without compromising thrombotic event prevention compared to dual-antiplatelet therapy (DAPT). SAPT is recommended for patients without oral anticoagulation needs.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Clinical Trials

Background:

  • Transcatheter aortic valve implantation (TAVI) is a standard treatment for symptomatic severe aortic stenosis.
  • The optimal postoperative antiplatelet regimen following TAVI remains uncertain.
  • This meta-analysis evaluates the safety and efficacy of single-antiplatelet therapy (SAPT) versus dual-antiplatelet therapy (DAPT) post-TAVI.

Approach:

  • A systematic review and meta-analysis of randomized controlled trials and cohort studies published before February 2021.
  • Searched PubMed, Embase, and Cochrane Library databases.
  • Calculated odds ratios (ORs) with 95% confidence intervals (CIs) to compare outcomes.

Key Points:

  • Nine studies involving 19,277 patients were analyzed.
  • Short-term: DAPT showed higher bleeding rates (OR, 3.00) but no significant difference in thrombotic events or mortality compared to SAPT.
  • Long-term: DAPT was associated with increased bleeding (OR, 1.85) with no benefit in thrombotic events or mortality versus SAPT.
  • Trial sequential analysis confirmed DAPT offers no advantage for mortality/thrombotic events and increases bleeding risk.

Conclusions:

  • Single-antiplatelet therapy (SAPT) is a safe and effective antiplatelet strategy after TAVI.
  • SAPT should be considered the standard of care for patients without contraindications for oral anticoagulation.
  • This recommendation is particularly relevant for long-term follow-up post-TAVI.
Abstract

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