title: Antiplatelet therapy following transcatheter aortic valve implantation.
abstract: OBJECTIVE
  There is limited evidence to support decision making on antiplatelet therapy following transcatheter aortic valve implantation (TAVI). Our aim was to assess the efficacy and safety of aspirin-only (ASA) versus dual antiplatelet therapy (DAPT) following TAVI.
  
  
  METHODS
  We performed a systematic review and pooled analysis of individual patient data from 672 participants comparing single versus DAPT following TAVI. Primary endpoint was defined as the composite of net adverse clinical and cerebral events (NACE) at 1 month, including all-cause mortality, acute coronary syndrome (ACS), stroke, life-threatening and major bleeding.
  
  
  RESULTS
  At 30 days a NACE rate of 13% was observed in the ASA-only and in 15% of the DAPT group (OR 0.83, 95% CI 0.48 to 1.43, p=0.50). A tendency towards less life-threatening and major bleeding was observed in patients treated with ASA (OR 0.56, 95% CI 0.28 to 1.11, p=0.09). Also, ASA was not associated with an increased all-cause mortality (OR 0.91, 95% CI 0.36 to 2.27, p=0.83), ACS (OR 0.5, 95% CI 0.05 to 5.51, p=0.57) or stroke (OR 1.21; 95% CI 0.36 to 4.03, p=0.75).
  
  
  CONCLUSIONS
  No difference in 30-day NACE rate was observed between ASA-only or DAPT following TAVI. Moreover, a trend towards less life-threatening and major bleeding was observed in favour of ASA. Consequently the additive value of clopidogrel warrants further investigation.
authors.affiliation: Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Mariëlla E C J
authors.initials: ME
authors.lastname: Hassell
authors.affiliation: Department of Cardiology, Brighton and Sussex University Hospitals, Sussex, UK.
authors.forename: David
authors.initials: D
authors.lastname: Hildick-Smith
authors.affiliation: Department of Cardiology, University hospital of Rouen, Hospital Charles Nicolle, Rouen, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Durand
authors.affiliation: Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Wouter J
authors.initials: WJ
authors.lastname: Kikkert
authors.affiliation: Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Esther M A
authors.initials: EM
authors.lastname: Wiegerinck
authors.affiliation: Department of Advanced Biomedical Sciences, University of Napoli "Federico II", Napoli, Italy.
authors.forename: Eugenio
authors.initials: E
authors.lastname: Stabile
authors.affiliation: Cardiologia Interventistica Strutturale Policlinico Tor Vergata, Università degli Studi di Roma Tor Vergata, Roma, Italy.
authors.forename: Gian Paolo
authors.initials: GP
authors.lastname: Ussia
authors.affiliation: Department of Cardiology, Brighton and Sussex University Hospitals, Sussex, UK.
authors.forename: Sumeet
authors.initials: S
authors.lastname: Sharma
authors.affiliation: Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Jan
authors.initials: J
authors.lastname: Baan
authors.affiliation: Department of Cardiology, University hospital of Rouen, Hospital Charles Nicolle, Rouen, France.
authors.forename: Hélène
authors.initials: H
authors.lastname: Eltchaninoff
authors.affiliation: Laboratory of Invasive Cardiology, Clinica Montevergine, Mercogliano, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Rubino
authors.affiliation: Department of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Barbanti
authors.affiliation: Department of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy.
authors.forename: Corrado
authors.initials: C
authors.lastname: Tamburino
authors.affiliation: Department of Cardiology, Brighton and Sussex University Hospitals, Sussex, UK.
authors.forename: Petra
authors.initials: P
authors.lastname: Poliacikova
authors.affiliation: Department of Cardiology, University Paris descartes, AP-HP; European Georges Pompidou Hospital, Paris, France.
authors.forename: Didier
authors.initials: D
authors.lastname: Blanchard
authors.affiliation: Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Jan J
authors.initials: JJ
authors.lastname: Piek
authors.affiliation: Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Ronak
authors.initials: R
authors.lastname: Delewi
mesh_terms: D054058:Acute Coronary Syndrome / Q000209:etiology / Q000401:mortality; D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D001241:Aspirin / Q000009:adverse effects / Q000627:therapeutic use*; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D000077144:Clopidogrel; D004359:Drug Therapy, Combination; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D008297:Male; D016017:Odds Ratio; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000209:etiology / Q000401:mortality; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin