Lin Xiaoxiao, Wang Shuai, Wang Long, Guan Yihong, Huang Jinyu
Zhejiang Chinese Medical University, Hangzhou, China.
Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Stress: No. 261, Huansha Road, Hangzhou, 310006, China.
Cardiovasc Drugs Ther. 2022 Apr;36(2):271-278. doi: 10.1007/s10557-021-07145-7. Epub 2021 Feb 11.
The current American College of Cardiology and American Heart Association (ACC/AHA) guidelines recommend dual antiplatelet therapy (DAPT) with aspirin and clopidogrel for 6 months followed by lifelong aspirin after transcatheter aortic valve replacement (TAVR). However, studies that have DAPT with aspirin following TAVR have questioned this recommendation as DAPT has been associated with more bleeding events compared to aspirin. We performed a systematic review and meta-analysis of all the RCTs comparing DAPT (aspirin plus clopidogrel) with aspirin alone as antithrombotic treatment following transcatheter aortic valve replacement.
The databases of Embase, PubMed, and Cochrane library were searched from inception to Oct 1, 2020, and randomized controlled trials (RCTs) reporting aspirin plus clopidogrel with aspirin alone as antithrombotic treatment after TAVI were included. Revman 5.3 was used to conduct the analysis.
After screening 152 articles, four studies involving 1086 patients (541 patients in the aspirin group and 545 patients in the DAPT group) were included. The results demonstrated that, at 30 days follow-up, compared with DAPT, aspirin was not associated with a statistically significant difference in the rate of bleeding events (RR = 1.22, 95% CI 0.62 to 2.39, P = 0.57), all-cause mortality (RR = 1.21, 95% CI 0.52 to 2.84, P = 0.66), stroke (RR = 0.81, 95% CI 0.24 to 2.79, P = 0.74), and MI (RR = 4.00, 95% CI 0.45 to 35.22, P = 0.21). However, at the 6 to 12 months follow-up, DAPT appeared to increase the risk of bleeding events compared with aspirin alone (RR = 1.67, 95% CI 1.24 to 2.24, P < 0.001), and there was no significant difference in the rate of all-cause mortality (RR = 0.89, 95% CI 0.53 to 1.48, P = 0.65), stroke (RR = 1.04, 95% CI 0.57 to 1.92, P = 0.90), and MI (RR = 1.65, 95% CI 0.52 to 5.26, P = 0.40) among the two groups.
Our systematic review and meta-analysis suggested that aspirin alone could decrease the risk of bleeding and was not associated with higher risk of mortality, stroke or myocardial infarction compared with DAPT.
美国心脏病学会和美国心脏协会（ACC/AHA）现行指南推荐，经导管主动脉瓣置换术（TAVR）后采用阿司匹林和氯吡格雷进行6个月的双重抗血小板治疗（DAPT），之后终身服用阿司匹林。然而，TAVR术后使用阿司匹林进行DAPT的研究对这一推荐提出了质疑，因为与阿司匹林相比，DAPT与更多出血事件相关。我们对所有比较DAPT（阿司匹林加氯吡格雷）与单独使用阿司匹林作为经导管主动脉瓣置换术后抗血栓治疗的随机对照试验（RCT）进行了系统评价和荟萃分析。
检索了Embase、PubMed和Cochrane图书馆数据库自建库至2020年10月1日的数据，并纳入了报告TAVI术后阿司匹林加氯吡格雷与单独使用阿司匹林作为抗血栓治疗的随机对照试验（RCT）。使用Revman 5.3进行分析。
在筛选了152篇文章后，纳入了4项研究，共1086例患者（阿司匹林组541例，DAPT组545例）。结果表明，在30天随访时，与DAPT相比，阿司匹林在出血事件发生率（RR = 1.22，95%CI 0.62至2.39，P = 0.57）、全因死亡率（RR = 1.21，95%CI 0.52至2.84，P = 0.66）、中风（RR = 0.81，95%CI 0.24至2.79，P = 0.74）和心肌梗死（RR = 4.00，95%CI 0.45至35.22，P = 0.21）方面无统计学显著差异。然而，在6至12个月随访时，与单独使用阿司匹林相比，DAPT似乎增加了出血事件风险（RR =
