title: Dual versus single antiplatelet therapy in patients undergoing transcatheter aortic valve replacement: a systematic review and meta-analysis.
abstract: BACKGROUND
  Although dual antiplatelet therapy (DAPT) with clopidogrel and aspirin is a widely accepted strategy in patients undergoing transcatheter aortic valve replacement (TAVR), this approach is not evidence based. We therefore sought to systematically review the current evidence for this practice in terms of 30-day outcome looking at stroke, MI, bleeding, and death.
  
  
  METHODS
  Relevant studies were identified through electronic literature search. Studies involving single antiplatelet therapy (SAPT) and DAPT in patients undergoing TAVR were included. Study specific risk ratios were calculated and combined using random-effects model meta-analysis.
  
  
  RESULTS
  Analysis of data from 410 patients, stroke occurred in seven (3.16%) of SAPT and six (3.17%) of DAPT RR=1.03 (95% CI, 0.36-2.96, P=0.96). In analysis of 530 patients, MI occurred in three (1.07%) of SAPT and one (0.40%) of DAPT RR=1.97 (95% CI, 0.29-13.29, P=0.49), significant bleeding (major, life threatening and bleeding requiring transfusion) occurred in 20 (7.11%) of SAPT and 43 (17.27%) of DAPT RR=0.41 (95% CI, 0.25-0.69, P=0.0006). Number needed to harm for major or life threatening bleeding was 10. Death occurred in 15 (6.78%) of SAPT and 15 (7.94%) of DAPT (RR 0.91; 95% CI 0.46-1.79, P=0.78).
  
  
  CONCLUSIONS
  Our meta-analysis suggests that at 30 days following TAVR there is no difference between post-procedural SAPT versus DAPT for the risk of stroke or MI and DAPT may have a higher bleeding risk. Adequately powered RCTs are warranted to clarify the optimal antiplatelet treatment strategy following TAVR.
authors.affiliation: Department of Internal Medicine, Reading Health System, West Reading, Pennsylvania, USA 19611.
authors.forename: Madan Raj
authors.initials: MR
authors.lastname: Aryal
authors.affiliation: Department of Internal Medicine, Reading Health System, West Reading, Pennsylvania, USA 19611.
authors.forename: Paras
authors.initials: P
authors.lastname: Karmacharya
authors.affiliation: Division of Cardiovascular Disease, Mayo Clinic College of Medicine, Phoenix, Arizona, USA 85054.
authors.forename: Anil
authors.initials: A
authors.lastname: Pandit
authors.affiliation: Division of Cardiovascular Disease, Mayo Clinic College of Medicine, Phoenix, Arizona, USA 85054.
authors.forename: Fayaz
authors.initials: F
authors.lastname: Hakim
authors.affiliation: Department of Internal Medicine, Reading Health System, West Reading, Pennsylvania, USA 19611. Electronic address: ranjanrp@gmail.com.
authors.forename: Ranjan
authors.initials: R
authors.lastname: Pathak
authors.affiliation: Department of Internal Medicine, Reading Health System, West Reading, Pennsylvania, USA 19611.
authors.forename: Naba Raj
authors.initials: NR
authors.lastname: Mainali
authors.affiliation: Department of Internal Medicine, Reading Health System, West Reading, Pennsylvania, USA 19611.
authors.forename: Anene
authors.initials: A
authors.lastname: Ukaigwe
authors.affiliation: Department of Internal Medicine, Reading Health System, West Reading, Pennsylvania, USA 19611.
authors.forename: Maryam
authors.initials: M
authors.lastname: Mahmood
authors.affiliation: Department of Internal Medicine, Reading Health System, West Reading, Pennsylvania, USA 19611.
authors.forename: Madan
authors.initials: M
authors.lastname: Badal
authors.affiliation: Division of Cardiovascular Disease, Mayo Clinic College of Medicine, Phoenix, Arizona, USA 85054.
authors.forename: F David
authors.initials: FD
authors.lastname: Fortuin
mesh_terms: D001241:Aspirin / Q000008:administration & dosage* / Q000009:adverse effects; D000077144:Clopidogrel; D004359:Drug Therapy, Combination / Q000009:adverse effects; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced / Q000401:mortality; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000139:chemically induced / Q000401:mortality; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D020521:Stroke / Q000139:chemically induced / Q000401:mortality; D013988:Ticlopidine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D013997:Time Factors; D065467:Transcatheter Aortic Valve Replacement
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin
keywords: Dual antiplatelet therapy; Meta-analysis; Single antiplatelet therapy; Systematic review; Transcatheter aortic valve replacement