Aspirin monotherapy (ASA) reduced the combined risk of thrombotic and bleeding events compared against dual antiplatelet therapy (DAPT) in patients receiving transcatheter aortic valve replacement (TAVR).
This meta-analysis has only reproduced smaller randomize study outcomes and does not include the OCEAN-TAVI registry, the only one that has shown something different so far.
Even though ASA is positioned as the most acceptable option after TAVR, guidelines still recommend 3-to-6-month DAPT.
4 randomized studies with over 1,000 patients comparing ASA vs DAPT after TAVR were analyzed in the present meta-analysis. Primary end point was a combination of all-cause mortality, life threatening death, stroke or MI.
This occurred far less frequently in the group receiving only ASA, both at 30 days (10.3% vs 14.7%, p=0.034) and 3 months (11.0% versus 16.5%, p=0.02) compared with patients receiving DAPT.
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Post TAVR anticoagulation will remain controversial as long as the information from randomized studies, registries and guidelines remains inconsistent. In this regard, being the TAVR population so heterogeneous, the final answer will take longer.
Conclusion
Patients with no oral anticoagulation indication undergoing TAVR will benefit from aspirin monotherapy compared against dual antiplatelet therapy.
JAHA-120-019604freeOriginal Title: Aspirin Alone Versus Dual Antiplatelet Therapy After Transcatheter Aortic Valve Implantation: A Systematic Review and Patient-Level Meta-Analysis.
Reference: Jorn Brouwer et al. J Am Heart Assoc. 2021 Apr 20;10(8):e019604. doi: 10.1161/JAHA.120.019604.s.
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