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DUAL ANTIPLATELET THERAPY VERSUS SINGLE ANTIPLATELET REGIMEN WITH OR WITHOUT ANTICOAGULATION IN TRANSCATHETER AORTIC VALVE REPLACEMENT: INDIRECT COMPARISON AND META-ANALYSIS
1207 JACC March 21, 2017 Volume 69, Issue 11
Interventional Cardiology DUAL ANTIPLATELET THERAPY VERSUS SINGLE ANTIPLATELET REGIMEN WITH OR WITHOUT ANTICOAGULATION IN TRANSCATHETER AORTIC VALVE REPLACEMENT: INDIRECT COMPARISON AND META-ANALYSIS Poster Contributions Poster Hall, Hall C Saturday, March 18, 2017, 9:45 a.m.-10:30 a.m. Session Title: Interventional Cardiology: TAVR 2 Abstract Category: 17. Interventional Cardiology: Aortic Valve Disease Presentation Number: 1195-169 Authors: Monica Verdoia, Lucia Barbieri, Paolo Marino, Harry Suryapranata, Giuseppe De Luca, AOU Maggiore della Carità, Università del Piemonte Orientale, Novara, Italy Background: Uncertainty still exists on the correct management of antithrombotic therapies after Transcatheter Aortic Valve Replacement (TAVR). Dual antiplatelet therapy (DAPT) is currently recommended on empirical basis, although having been claimed to increase bleedings without offering enhanced ischemic protection. Therefore, the aim of present meta-analysis was to assess the safety and effectiveness of DAPT in patients undergoing TAVR.
Methods: Literature archives and main scientific sessions were scanned for studies comparing different antithrombotic regimes after TAVR. Primary efficacy endpoint was 30-days overall mortality. Secondary endpoints were stroke and major bleedings (per protocol definition).
Results: We included 9 studies, 5 comparing DAPT with ASA monotherapy, while 4 DAPT with mono-antiplatelet therapy (MAPT) + oral anticoagulation (OAC). In a total population of 7991 patients, 72% were on DAPT. Transfemoral approach was preferred for TAVI. DAPT duration ranged from 3 to 6 months. Median follow-up was 3.5 months. Death occurred in 12.8% of patients, with a significant lower mortality in the DAPT group (12.2% vs 14.4%, OR[95%CI]=0.81[0.70-0.93], p=0.003, phet=0.93). Similar benefits were observed against ASA monotherapy (OR[95%CI]=0.80[0.69-0.93], p=0.004, phet=0.60), while not reaching statistical significance for MAPT+OAC (OR[95%CI]=0.86[0.55-1.35], p=0.51, phet=0.97). A similar trend for benefit with DAPT was observed for stroke (OR[95%CI]=0.83[0.63-1.10], p=0.20, phet=0.67), with no significant increase in the rate of major bleedings (OR[95%CI]=1.69[0.86-3.31], p=0.13, phet<0.0001). By indirect comparison analysis, no benefit in survival, stroke or bleedings was identified for additional anticoagulation as compared to MAPT alone. Conclusions: Present meta-analysis provides evidence for the current recommendation of DAPT as the preferred antithrombotic strategy in patients undergoing TAVR. In fact, DAPT provided a significant reduction in mortality and a slight benefit in stroke, with no increase in major bleedings, as compared to MAPT. The strategy of ASA and anticoagulation did not provide significant benefits as compared to MAPT or DAPT
Interventional Cardiology DUAL ANTIPLATELET THERAPY VERSUS SINGLE ANTIPLATELET REGIMEN WITH OR WITHOUT ANTICOAGULATION IN TRANSCATHETER AORTIC VALVE REPLACEMENT: INDIRECT COMPARISON AND META-ANALYSIS Poster Contributions Poster Hall, Hall C Saturday, March 18, 2017, 9:45 a.m.-10:30 a.m. Session Title: Interventional Cardiology: TAVR 2 Abstract Category: 17. Interventional Cardiology: Aortic Valve Disease Presentation Number: 1195-169 Authors: Monica Verdoia, Lucia Barbieri, Paolo Marino, Harry Suryapranata, Giuseppe De Luca, AOU Maggiore della Carità, Università del Piemonte Orientale, Novara, Italy Background: Uncertainty still exists on the correct management of antithrombotic therapies after Transcatheter Aortic Valve Replacement (TAVR). Dual antiplatelet therapy (DAPT) is currently recommended on empirical basis, although having been claimed to increase bleedings without offering enhanced ischemic protection. Therefore, the aim of present meta-analysis was to assess the safety and effectiveness of DAPT in patients undergoing TAVR.
Methods: Literature archives and main scientific sessions were scanned for studies comparing different antithrombotic regimes after TAVR. Primary efficacy endpoint was 30-days overall mortality. Secondary endpoints were stroke and major bleedings (per protocol definition).
Results: We included 9 studies, 5 comparing DAPT with ASA monotherapy, while 4 DAPT with mono-antiplatelet therapy (MAPT) + oral anticoagulation (OAC). In a total population of 7991 patients, 72% were on DAPT. Transfemoral approach was preferred for TAVI. DAPT duration ranged from 3 to 6 months. Median follow-up was 3.5 months. Death occurred in 12.8% of patients, with a significant lower mortality in the DAPT group (12.2% vs 14.4%, OR[95%CI]=0.81[0.70-0.93], p=0.003, phet=0.93). Similar benefits were observed against ASA monotherapy (OR[95%CI]=0.80[0.69-0.93], p=0.004, phet=0.60), while not reaching statistical significance for MAPT+OAC (OR[95%CI]=0.86[0.55-1.35], p=0.51, phet=0.97). A similar trend for benefit with DAPT was observed for stroke (OR[95%CI]=0.83[0.63-1.10], p=0.20, phet=0.67), with no significant increase in the rate of major bleedings (OR[95%CI]=1.69[0.86-3.31], p=0.13, phet<0.0001). By indirect comparison analysis, no benefit in survival, stroke or bleedings was identified for additional anticoagulation as compared to MAPT alone. Conclusions: Present meta-analysis provides evidence for the current recommendation of DAPT as the preferred antithrombotic strategy in patients undergoing TAVR. In fact, DAPT provided a significant reduction in mortality and a slight benefit in stroke, with no increase in major bleedings, as compared to MAPT. The strategy of ASA and anticoagulation did not provide significant benefits as compared to MAPT or DAPT