Ahmad Yousif, Demir Ozan, Rajkumar Christopher, Howard James P, Shun-Shin Matthew, Cook Christopher, Petraco Ricardo, Jabbour Richard, Arnold Ahran, Frame Angela, Sutaria Nilesh, Ariff Ben, Kanaganayagam Gajen, Francis Darrel, Mayet Jamil, Mikhail Ghada, Malik Iqbal, Sen Sayan
International Centre for Circulatory Health, Hammersmith Hospital, Imperial College London, London, UK.
Open Heart. 2018 Jan 26;5(1):e000748. doi: 10.1136/openhrt-2017-000748. eCollection 2018.
International guidelines recommend the use of dual antiplatelet therapy (DAPT) after transcatheter aortic valve implantation (TAVI). The recommended duration of DAPT varies between guidelines. In this two-part study, we (1) performed a structured survey of 45 TAVI centres from around the world to determine if there is consensus among clinicians regarding antiplatelet therapy after TAVI; and then (2) performed a systematic review of all suitable studies (randomised controlled trials (RCTs) and registries) to determine if aspirin monotherapy can be used instead of DAPT.
A structured electronic survey regarding antiplatelet use after TAVI was completed by 45 TAVI centres across Europe, Australasia and the USA. A systematic review of TAVI RCTs and registries was then performed comparing DAPT duration and incidence of stroke, bleeding and death. A variance weighted least squared metaregression was then performed to determine the relationship of antiplatelet therapy and adverse events.
82.2% of centres routinely used DAPT after TAVI. Median duration was 3 months. 13.3% based their practice on guidelines. 11 781 patients (26 studies) were eligible for the metaregression. There was no benefit of DAPT over aspirin monotherapy for stroke (P=0.49), death (P=0.72) or bleeding (P=0.91).
Aspirin monotherapy appears to be as safe and effective as DAPT after TAVI.
国际指南推荐经导管主动脉瓣植入术（TAVI）后使用双联抗血小板治疗（DAPT）。不同指南推荐的DAPT持续时间有所不同。在这项分为两部分的研究中，我们（1）对来自世界各地的45个TAVI中心进行了结构化调查，以确定临床医生在TAVI后抗血小板治疗方面是否存在共识；然后（2）对所有合适的研究（随机对照试验（RCT）和注册研究）进行系统评价，以确定是否可以使用阿司匹林单药治疗替代DAPT。
欧洲、澳大拉西亚和美国的45个TAVI中心完成了一项关于TAVI后抗血小板使用情况的结构化电子调查。随后对TAVI的RCT和注册研究进行系统评价，比较DAPT持续时间以及中风、出血和死亡的发生率。然后进行方差加权最小二乘元回归，以确定抗血小板治疗与不良事件之间的关系。
82.2%的中心在TAVI后常规使用DAPT。中位持续时间为3个月。13.3%的中心依据指南开展实践。11781例患者（26项研究）符合元回归分析条件。在中风（P = 0.49）、死亡（P = 0.72）或出血（P = 0.91）方面，DAPT并不优于阿司匹林单药治疗。
TAVI后阿司匹林单药治疗似乎与DAPT一样安全有效。
