Objective: We aim to evaluate the efficacy of dual versus single anti-platelet therapy (SAPT) after TAVR through a systematic review and meta-analysis of published research.
Background: Dual antiplatelet therapy (DAPT) with aspirin and clopidogrel is a commonly practiced strategy after transcatheter aortic valve replacement (TAVR). However, there is lack of sufficient evidence supporting this approach.
Method: We searched PubMed, EMBASE, the Cochrane Central Register of Controlled trials, and the clinical trial registry maintained at clinicaltrials.gov for randomized control trials (RCT) and observational studies comparing DAPT with SAPT post TAVR. Event rates were compared using a forest plot of relative risk with 95% confidence intervals using a random-effects model assuming inter-study heterogeneity.
Results: A total of six studies (3 RCTs and 3 observational studies, n = 840) were included in the final analysis. Compared to SAPT, DAPT was associated with increased risk of significant bleeding (life threatening and major) [RR = 2.52 (95% CI 1.62-3.92, P < 0.0001)] with the number needed to harm for major or life-threatening bleeding calculated to be 10.4. There was no significant difference in the incidence of stroke [RR = 1.06 (95% CI, 0.43-2.60, P = 0.90)], spontaneous myocardial infarction [RR = 2.08 (95% CI, 0.56-7.70, P = 0.27)] and all-cause mortality [RR = 1.18 (95% CI, 0.68-2.05, P = 0.56] in the DAPT and SAPT groups.
Conclusion: In this small meta-analysis of DAPT versus SAPT after TAVR, DAPT did not prevent stroke, myocardial infarction or death while the risk of bleeding was higher. Results from ongoing trials are awaited to determine the best anti-thrombotic approach after TAVR.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1002/ccd.27582 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Variability in Coagulation Profiles in Patients with Chronic Kidney Disease and Peripheral Artery Disease.
Ann Vasc Surg
January 2025
Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA. Electronic address:
Objectives: Chronic Kidney Disease (CKD) has been associated with a prothrombotic state. CKD affects hemostasis through altered platelet function and coagulation factors. Traditional tests provide limited insight into these changes.
View Article and Find Full Text PDFAntithrombotic therapy following lower extremity endovascular revascularization: The results of a survey of vascular specialists.
JVS Vasc Insights
October 2024
Division of Vascular Surgery, University of Pittsburgh.
Objective: Antithrombotic therapy improves endovascular intervention outcomes for peripheral artery disease. However, there are limited data guiding the choice and duration of these adjuvant therapies. Thus, we explored current antithrombotic prescribing preferences among vascular interventionalists, hypothesizing that there are varied and inconsistent treatment practices among providers.
View Article and Find Full Text PDFParsimonious versus extensive bleeding score: can we simplify risk stratification after percutaneous coronary intervention and reduce bleeding events by de-escalation of the antiplatelet strategy?
Open Heart
January 2025
Cardiology, Radboudumc, Nijmegen, The Netherlands
Background And Aims: Due to the multitude of risk factors outlined in the guidelines, personalised dual antiplatelet therapy (DAPT) guidance after percutaneous coronary intervention (PCI) is complex. A simplified method was created to facilitate the use of risk stratification. We aimed to compare the predictive and prognostic value of the 'Zuidoost Nederland Hart Registratie' (ZON-HR) classification for bleeding risk with the PREdicting bleeding Complications In patients undergoing Stent implantation and subsEquent DAPT (PRECISE-DAPT) score and to determine the effect of ticagrelor monotherapy versus DAPT in patients with or without high bleeding risk (HBR).
View Article and Find Full Text PDFContrastive learning with transformer for adverse endpoint prediction in patients on DAPT post-coronary stent implantation.
Front Cardiovasc Med
January 2025
Department of Artificial Intelligence and Informatics, Mayo Clinic, Jacksonville, FL, United States.
Background: Effective management of dual antiplatelet therapy (DAPT) following drug-eluting stent (DES) implantation is crucial for preventing adverse events. Traditional prognostic tools, such as rule-based methods or Cox regression, despite their widespread use and ease, tend to yield moderate predictive accuracy within predetermined timeframes. This study introduces a new contrastive learning-based approach to enhance prediction efficacy over multiple time intervals.
View Article and Find Full Text PDFClinical Outcomes and Safety Profiles of Generic Versus Brand-Name Clopidogrel in Patients Following Coronary Artery Stent Placement.
Clin Transl Sci
February 2025
The Cardiovascular Department, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
Coronary artery disease remains a significant global health issue and is a leading cause of mortality. Dual antiplatelet therapy, including clopidogrel, is essential for preventing stent thrombosis after coronary artery stenting. This study assessed the comparative efficacy and safety of generic versus brand-name clopidogrel in a large Taiwanese cohort.
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!