Hu Xu, Yang Fu-Yao, Wang Yan, Zhang Yi, Chen Mao
West China School of Medicine, West China Hospital, Sichuan University, Chengdu, China.
Department of Cardiology, West China Hospital, Sichuan University, Chengdu,
Cardiology. 2018;141(1):52-65. doi: 10.1159/000490307. Epub 2018 Oct 26.
Although dual antiplatelet therapy (DAPT) with aspirin and clopidogrel is currently recommended in patients after transcatheter aortic valve implantation (TAVI), this practice is not supported by sufficient evidence. This study was performed to compare DAPT to single antiplatelet therapy (SAPT).
An electronic search was completed of PubMed, Embase, Ovid Medline, Web of Science, and Cochrane Central Register of Controlled Trials. Studies comparing DAPT versus SAPT in patients undergoing TAVI were included.
Seven studies incorporating 1,445 patients were eligible for the present meta-analysis. There were no significant differences on 30-day all-cause mortality (OR 1.19, 95% CI 0.63-2.25, p = 0.593), 6-month all-cause mortality (OR 1.11, 95% CI 0.49-2.53, p = 0.796), or 1-year all-cause mortality (OR 1.19, 95% CI 0.63- 2.25, p = 0.593). DAPT was associated with an increased risk for 30-day (OR 2.91, 95% CI 1.85-4.58, p < 0.01), 6-month (OR 2.54, 95% CI 1.26-5.10, p < 0.001), and 1-year major and lethal bleeding (OR 2.65, 95% CI 1.04-6.77, p = 0.041) based on 896, 337, and 583 patients, respectively, compared to SAPT.
Compared to SAPT, DAPT was not shown to be superior in reducing thrombotic events, but presented an increased risk of major/life-threatening bleeding. More randomized controlled trials are needed to provide further evidence.
尽管目前推荐在经导管主动脉瓣植入术（TAVI）后患者中使用阿司匹林和氯吡格雷进行双重抗血小板治疗（DAPT），但这种做法缺乏充分证据支持。本研究旨在比较DAPT与单一抗血小板治疗（SAPT）。
完成了对PubMed、Embase、Ovid Medline、Web of Science和Cochrane对照试验中央登记库的电子检索。纳入了比较TAVI患者中DAPT与SAPT的研究。
七项纳入1445例患者的研究符合本荟萃分析的条件。在30天全因死亡率（比值比1.19，95%置信区间0.63 - 2.25，p = 0.593）、6个月全因死亡率（比值比1.11，95%置信区间0.49 - 2.53，p = 0.796）或1年全因死亡率（比值比1.19，95%置信区间0.63 - 2.25，p = 0.593）方面无显著差异。与SAPT相比，基于分别896例、337例和583例患者，DAPT与30天（比值比2.91，95%置信区间1.85 - 4.58，p < 0.01）、6个月（比值比2.54，95%置信区间1.26 - 5.10，p < 0.001）和1年严重及致死性出血风险增加相关（比值比2.65，95%置信区间1.04 - 6.77，p = 0.041）。
与SAPT相比，DAPT在降低血栓形成事件方面未显示出优势，但严重/危及生命的出血风险增加。需要更多随机对照试验以提供进一步证据。
