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Open Heart. 2018 Jan 26;5(1):e000748. doi: 10.1136/openhrt-2017-000748. eCollection 2018.

Optimal antiplatelet strategy after transcatheter aortic valve implantation: a meta-analysis.

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International Centre for Circulatory Health, Hammersmith Hospital, Imperial College London, London, UK.



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.


antiplatelet treatment; aortic valve disease; percutaneous valve therapy; stroke

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