%0 Journal Article %A Yousif Ahmad %A Ozan Demir %A Christopher Rajkumar %A James P Howard %A Matthew Shun-Shin %A Christopher Cook %A Ricardo Petraco %A Richard Jabbour %A Ahran Arnold %A Angela Frame %A Nilesh Sutaria %A Ben Ariff %A Gajen Kanaganayagam %A Darrel Francis %A Jamil Mayet %A Ghada Mikhail %A Iqbal Malik %A Sayan Sen %T Optimal antiplatelet strategy after transcatheter aortic valve implantation: a meta-analysis %D 2018 %R 10.1136/openhrt-2017-000748 %J Open Heart %P e000748 %V 5 %N 1 %X 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. %U https://openheart.bmj.com/content/openhrt/5/1/e000748.full.pdf