You are here

Article Text

Article menu

Download PDFPDF

Aortic and vascular disease
Original research article
Optimal antiplatelet strategy after transcatheter aortic valve implantation: a meta-analysis
  1. Yousif Ahmad,
  2. Ozan Demir,
  3. Christopher Rajkumar,
  4. James P Howard,
  5. Matthew Shun-Shin,
  6. Christopher Cook,
  7. Ricardo Petraco,
  8. Richard Jabbour,
  9. Ahran Arnold,
  10. Angela Frame,
  11. Nilesh Sutaria,
  12. Ben Ariff,
  13. Gajen Kanaganayagam,
  14. Darrel Francis,
  15. Jamil Mayet,
  16. Ghada Mikhail,
  17. Iqbal Malik and
  18. Sayan Sen
  1. International Centre for Circulatory Health, Hammersmith Hospital, Imperial College London, London, UK
  1. Correspondence to Dr Yousif Ahmad; y.ahmad{at}imperial.ac.uk

Abstract

Objective International guidelines recommend the use of dual antiplatelet therapy (DAPT) after transcatheter aortic valve implantation (TAVI). The recommended duration of DAPT varies between guidelines. In this two-part study, we (1) performed a structured survey of 45 TAVI centres from around the world to determine if there is consensus among clinicians regarding antiplatelet therapy after TAVI; and then (2) performed a systematic review of all suitable studies (randomised controlled trials (RCTs) and registries) to determine if aspirin monotherapy can be used instead of DAPT.

Methods A structured electronic survey regarding antiplatelet use after TAVI was completed by 45 TAVI centres across Europe, Australasia and the USA. A systematic review of TAVI RCTs and registries was then performed comparing DAPT duration and incidence of stroke, bleeding and death. A variance weighted least squared metaregression was then performed to determine the relationship of antiplatelet therapy and adverse events.

Results 82.2% of centres routinely used DAPT after TAVI. Median duration was 3 months. 13.3% based their practice on guidelines. 11 781 patients (26 studies) were eligible for the metaregression. There was no benefit of DAPT over aspirin monotherapy for stroke (P=0.49), death (P=0.72) or bleeding (P=0.91).

Discussion Aspirin monotherapy appears to be as safe and effective as DAPT after TAVI.

  • percutaneous valve therapy
  • antiplatelet treatment
  • aortic valve disease
  • stroke

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/openhrt-2017-000748

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    View Full Text

    Footnotes

    • Contributors All authors fulfil the International Committee of Medical Journal Editors (ICMJE) recommendations for authorship. Conceived and designed the research: YA, SS. Performed statistical analysis: YA, MSS, JPH, AA. Acquired the data: YA, OD, MSS, CC, AA, AF, NS, BA, GK, GM, IM. Drafted the manuscript: YA, OD, CR, CC, RP, RJ, DF, JM, SS. Made critical revision of the manuscript for key intellectual content: YA, OD, CR, JPH, MSS, CC, DF, JM, GM, IM, SS.

    • Funding This work was supported by the National Institute of Health Research Biomedical Research Centre at Imperial College London.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement The corresponding author agrees to share the source data upon reasonable request.