Abington Jefferson Health, Abington, Pennsylvnia.
Detroit Medical Center, Heart Hospital, Detroit, Michigan.
Am J Cardiol. 2021 Apr 15;145:111-118. doi: 10.1016/j.amjcard.2020.12.087. Epub 2021 Jan 15.
The relative safety and efficacy of aspirin versus dual antiplatelet therapy (DAPT; aspirin+clopidogrel) in patients who underwent transcatheter aortic valve implantation (TAVI) and did not have a long-term indication for oral anticoagulation remains controversial. Digital databases were searched to identify relevant articles. The major safety end point was bleeding, while the efficacy end points included after-TAVI ischemic and thrombotic events. Data were analyzed using a random effect model to calculate the pooled unadjusted odds ratio (OR) for dichotomous outcomes. Eleven studies comprising 4805 patients (aspirin 2258, DAPT 2547) were included in the quantitative analysis. Patients receiving aspirin-alone had significantly lower odds of all cause bleeding (OR 0.41, 95% CI 0.29 to .057, p <0.00001), major vascular bleeding (OR 0.51, 95% CI 0.34 to 0.77, p = 0.001), Valve Academic Research Consortium 2 (VARC-2) major bleeding (OR 0.50, 95% CI 0.30 to 0.83 p = 0.008), VARC-2 minor bleeding (OR 0.55, 95% CI 0.31 to 0.97, p = 0.04), transfusion requirement (OR 0.39, 95%CI 0.15 to 0.0.98, p = 0.05) and major vascular complications (OR0.41, 95% CI 0.26 to 0.66, p = 0.0002) compared with after-TAVI patients receiving both aspirin and clopidogrel. These was no significant difference in the odds of VARC-2 life threatening bleeding (OR 0.52, 95% CI 0.25 to 1.07, p = 0.08), prosthetic valve thrombosis (OR 1.17, 95% CI 0.22 to 6.30, p = 0.85), cardiac tamponade (OR 0.77, 95% CI 0.20 to 2.98, p = 0.70), conversion to open procedure (OR 1.99, 95 % CI 0.42 to 9.44, p = 0.39), MI (OR 0.79 95% CI 0.38 to 1.64, p = 0.52), transient ischemic attack (TIA) (OR 0.89, 95% CI 0.12 to 6.44, p = 0.91), major stroke (OR 0.68 95 % CI 0.43 to 1.08, p = 0.10), disabling stroke (0R 1.01, 95% CI 0.41 to 2.48, p = 0.99), cardiovascular mortality (OR 0.81 95% CI 0.38 to 1.74, p = 0.59) and all-cause mortality (OR 0.86, 95% CI 0.63 to 1.16, p = 0.31) between the 2 groups. In conclusion, after-TAVI patients who received aspirin alone had lower bleeding events with no significant differences in mortality and stroke rate compared with those who received DAPT.
经导管主动脉瓣置换术（TAVI）后未长期接受口服抗凝治疗的患者，阿司匹林与双联抗血小板治疗（DAPT；阿司匹林+氯吡格雷）的相对安全性和疗效仍存在争议。检索数字数据库以确定相关文章。主要安全性终点为出血，而疗效终点包括 TAVI 后缺血和血栓事件。使用随机效应模型分析数据，计算二分类结局的合并未调整优势比（OR）。11 项研究包括 4805 例患者（阿司匹林 2258 例，DAPT 2547 例）纳入定量分析。单独使用阿司匹林的患者全因出血的可能性显著降低（OR 0.41，95%CI 0.29 至 0.57，p<0.00001）、主要血管出血（OR 0.51，95%CI 0.34 至 0.77，p=0.001）、血管学术研究联合会 2 型（VARC-2）主要出血（OR 0.50，95%CI 0.30 至 0.83，p=0.008）、VARC-2 次要出血（OR 0.55，95%CI 0.31 至 0.97，p=0.04）、输血需求（OR 0.39，95%CI 0.15 至 0.98，p=0.05）和主要血管并发症（OR0.41，95%CI 0.26 至 0.66，p=0.0002）均低于接受阿司匹林和氯吡格雷的 TAVI 后患者。两组在 VARC-2 危及生命出血（OR 0.52，95%CI 0.25 至 1.07，p=0.08）、人工瓣膜血栓形成（OR 1.17，95%CI 0.22 至 6.30，p=0.85）、心脏压塞（OR 0.77，95%CI 0.20 至 2.98，p=0.70）、转为开放性手术（OR 1.99，95%CI 0.42 至 9.44，p=0.39）、心肌梗死（OR 0.79，95%CI 0.38 至 1.64，p=0.52）、短暂性脑缺血发作（TIA）（OR 0.89，95%CI 0.12 至 6.44，p=0.91）、主要中风（OR 0.68，95%CI 0.43 至 1.08，p=0.10）、致残性中风（OR 1.01，95%CI 0.41 至 2.48，p=0.99）、心血管死亡率（OR 0.81，95%CI 0.38 至 1.74，p=0.59）和全因死亡率（OR 0.86，95%CI 0.63 至 1.16，p=0.31）之间无显著差异。总之，与接受 DAPT 的患者相比，接受单独阿司匹林治疗的 TAVI 后患者出血事件发生率较低，死亡率和中风发生率无显著差异。
