POSTPROCEDURAL MONOTHERAPY WITH ASPIRIN VS DAPT AFTER TAVI - AN UPDATED META-ANALYSIS OF RANDOMIZED, CONTROL TRIALS

Background: Multiple studies have evaluated whether monotherapy with aspirin is superior to DAPT in patients who have undergone transcatheter aortic valve implantation (TAVI). Methods: A systematic review of Medline, Cochrane, and Embase was performed for RCTs that reported outcomes of patients undergoing TAVI who received post-procedural aspirin only vs those who received DAPT. Four RCTs met the eligibility criteria. Results: This meta-analysis includes 1,086 patients with a mean age 80.0±0.75 years; 50.3% were male. After a mean follow-up of 9.0±3.5 months, there was a significant benefit in the aspirin only group, when compared with the DAPT group, in all bleeding events (Risk Ratio [RR] 0.58, 95% Confidence Interval [CI] 0.44-0.76, p\u3c0.0001, relative risk reduction [RRR] 42%, absolute risk reduction [ARR] 9.1%). No statistically significant differences between groups were found in the other outcomes: all-cause mortality (RR 1.01, 95% CI 0.63-1.61, p=0.97), cardiovascular mortality (RR 1.07, 95% CI 0.54-2.12, p=0.84) or all stroke (RR 0.93, 95% CI 0.54-1.61, p=0.79). Conclusion: Monotherapy with aspirin following TAVI is associated with a lower risk of all bleeding events when compared with post-procedural DAPT. No differences between groups were seen in the other studied outcomes. However, the short mean follow-up period is an important limitation of the present study. Further studies with longer follow-up periods are needed before changes are implemented in the current TAVI guidelines%