TY - JOUR T1 - Optimal antiplatelet strategy after transcatheter aortic valve implantation: a meta-analysis JF - Open Heart JO - Open Heart DO - 10.1136/openhrt-2017-000748 VL - 5 IS - 1 SP - e000748 AU - Yousif Ahmad AU - Ozan Demir AU - Christopher Rajkumar AU - James P Howard AU - Matthew Shun-Shin AU - Christopher Cook AU - Ricardo Petraco AU - Richard Jabbour AU - Ahran Arnold AU - Angela Frame AU - Nilesh Sutaria AU - Ben Ariff AU - Gajen Kanaganayagam AU - Darrel Francis AU - Jamil Mayet AU - Ghada Mikhail AU - Iqbal Malik AU - Sayan Sen Y1 - 2018/01/01 UR - http://openheart.bmj.com/content/5/1/e000748.abstract N2 - 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. ER -