Aspirin vs dual antiplatelet therapy in patients undergoing TAVI

  • Alkhalil M & al.
  • Cardiovasc Drugs Ther
  • 15 Feb 2021

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • This meta-analysis suggests that the use of aspirin reduces the risk of bleeding without an increase in ischaemic events following transcatheter aortic valve implantation (TAVI) procedures compared with dual antiplatelet therapy (DAPT).

Why this matters

  • Findings support the results of the recently published POPular-TAVI trial reporting the safety of using aspirin over DAPT.
  • Findings together with the results of POPular-TAVI trial will inform physicians in formulating local and national guidelines on antiplatelet therapy in patients undergoing TAVI.

Study design

  • Meta-analysis of 4 randomised clinical trials, including 1086 patients receiving antiplatelet therapy following TAVI.
  • Funding: None disclosed.

Key results

  • After a median follow-up of 6 months, the aspirin vs DAPT group had a significantly lower risk of major or life-threatening bleeding (rate ratio [RR], 0.49; 95% CI, 0.31-0.78).
  • Aspirin was not associated with an increased risk of:
    • death (RR, 1.01; 95% CI, 0.62-1.65);
    • cardiovascular death (RR, 1.15; 95% CI, 0.56-2.36);
    • ischaemic stroke (RR, 0.93; 95% CI, 0.51-1.70); and
    • myocardial infarction (MI; RR, 0.53; 95% CI, 0.18-1.57).
  • Rates of adverse events (combination of major or life-threatening bleeding and death, MI or stroke) were 15.9% in the aspirin group vs 22.6% in the DAPT group.

Limitations

  • Limited number of studies.