Department of Cardiology St. Antonius Hospital Nieuwegein The Netherlands.
Department of Cardiology Quebec Heart & Lung Institute Laval University Quebec City Quebec Canada.
J Am Heart Assoc. 2021 Apr 20;10(8):e019604. doi: 10.1161/JAHA.120.019604. Epub 2021 Apr 16.
Background In patients undergoing transcatheter aortic valve implantation without an indication for oral anticoagulation, it is unclear whether single or dual antiplatelet therapy (DAPT) is necessary to minimize both the bleeding and thromboembolic risk. In this patient-level meta-analysis, we further investigate the effect of aspirin alone compared with DAPT for preventing both thromboembolic and bleeding events after transcatheter aortic valve implantation. Methods and Results We conducted a systematic review of all available randomized controlled trials comparing aspirin with DAPT. In total, 1086 patients were included across 4 eligible trials. The primary outcomes were the composite of all-cause mortality, major or life-threatening bleeding, stroke or myocardial infarction (first composite outcome), and the same composite excluding bleeding (second composite outcome), both tested at 30 days and 3 months. The first composite outcome occurred significantly less in the aspirin-alone group at 30 days (10.3% versus 14.7%, odds ratio [OR], 0.67; 95% CI, 0.46-0.97, =0.034) and 3 months (11.0% versus 16.5%, hazard ratio [HR], 0.66; 95% CI, 0.47-0.94, =0.02), compared with the DAPT group. The second composite outcome occurred in 5.5% and 6.6% at 30 days (OR, 0.83; 95% CI, 0.50-1.38, =0.47) and in 6.9% and 8.5% at 3 months in the aspirin-alone group compared with the DAPT group (HR, 0.82; 95% CI, 0.52-1.29, =0.39), respectively. Conclusions In patients without an indication for oral anticoagulation undergoing transcatheter aortic valve implantation, aspirin alone significantly reduced the composite of thromboembolic and bleeding events, and does not increase the composite of thromboembolic events after transcatheter aortic valve implantation, compared with DAPT.
在未接受抗凝治疗的行经导管主动脉瓣置换术患者中，尚不清楚是采用双联抗血小板治疗（DAPT）还是单联抗血小板治疗（SAPT）以最小化出血和血栓栓塞风险。在本患者水平的荟萃分析中，我们进一步研究了与 DAPT 相比，单独应用阿司匹林预防经导管主动脉瓣置换术后血栓栓塞和出血事件的效果。
我们对所有比较阿司匹林与 DAPT 的可用随机对照试验进行了系统评价。共有 4 项试验的 1086 例患者纳入研究。主要结局为全因死亡率、大出血或危及生命的出血、卒中和心肌梗死（首次复合结局）的复合事件，以及不包括出血的相同复合结局（第二次复合结局），分别在 30 天和 3 个月时进行评估。在 30 天（10.3%比 14.7%，比值比[OR]，0.67；95%CI，0.46-0.97，=0.034）和 3 个月（11.0%比 16.5%，风险比[HR]，0.66；95%CI，0.47-0.94，=0.02）时，与 DAPT 组相比，阿司匹林单药组首次复合结局的发生率显著降低。在 30 天（OR，0.83；95%CI，0.50-1.38，=0.47）和 3 个月（OR，0.82；95%CI，0.52-1.29，=0.39）时，阿司匹林单药组的第二次复合结局发生率分别为 5.5%和 6.6%，DAPT 组分别为 6.9%和 8.5%。
在未接受抗凝治疗行经导管主动脉瓣置换术的患者中，与 DAPT 相比，阿司匹林单药治疗可显著降低血栓栓塞和出血事件的复合发生率，且不会增加经导管主动脉瓣置换术后血栓栓塞事件的复合发生率。
