Imperial College London
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DrJamesHoward

Faculty of Medicine, National Heart & Lung Institute

Clinical Senior Lecturer in Cardiology (Cardiac MR and AI)
 
 
 
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james.howard1 Website CV

 
 
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Location

 

Block B Hammersmith HospitalHammersmith Campus

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Summary

 

Publications

Citation

BibTex format

@article{Ahmad:2022:10.1016/j.carrev.2021.01.016,
author = {Ahmad, Y and Howard, J and Madhavan, MV and Leon, MB and Makkar, RR},
doi = {10.1016/j.carrev.2021.01.016},
journal = {Cardiovascular Revascularization Medicine},
pages = {46--53},
title = {Single versus dual antiplatelet therapy after transcatheter aortic valve replacement: a meta-analysis of randomized clinical trials},
url = {http://dx.doi.org/10.1016/j.carrev.2021.01.016},
volume = {34},
year = {2022}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - BackgroundGuidelines recommend dual antiplatelet therapy (DAPT) after transcatheter aortic valve replacement (TAVR) but guidelines predate the publication of the largest randomized trial. There have been few trials in the field to date, and with a small number of total patients; pooling their results may therefore be helpful.MethodsWe systematically identified all randomized trials comparing SAPT to DAPT after TAVR. The primary endpoint was the risk of major bleeding. Secondary endpoints included all bleeding, life-threatening bleeding, stroke, myocardial infarction, death and cardiac death.ResultsFour trials, randomizing 1086 participants, were eligible (541 randomized to SAPT and 545 randomized to DAPT). The weighted mean follow-up was 9.1 months. The risk of major bleeding was significantly increased after DAPT (relative risk (RR) 2.36, 95% confidence interval (CI) 1.27 to 4.40, P = 0.007). There was a similar increased risk for all bleeding (RR 1.65, 95% CI 1.24 to 2.19, P < 0.001), although not for life-threatening bleeding (RR 1.44, 95% CI 0.74 to 2.77, P = 0.282). There were no significant differences in the risk of stroke, myocardial infarction (MI), death or cardiac death. There was no heterogeneity observed for any endpoint (I2 = 0.0%).ConclusionsDAPT after TAVR is associated with an increased risk of major bleeding and all bleeding. There is no evidence of a significant difference between DAPT or SAPT for the risks of stroke, MI, death or cardiac death. However, the total number of patients randomized is small and the duration of follow-up is short. Larger scale randomized trials with longer follow-up are required to assess for any potential differences in ischemic endpoints or mortality.
AU  - Ahmad,Y
AU  - Howard,J
AU  - Madhavan,MV
AU  - Leon,MB
AU  - Makkar,RR
DO  - 10.1016/j.carrev.2021.01.016
EP  - 53
PY  - 2022///
SN  - 1553-8389
SP  - 46
TI  - Single versus dual antiplatelet therapy after transcatheter aortic valve replacement: a meta-analysis of randomized clinical trials
T2  - Cardiovascular Revascularization Medicine
UR  - http://dx.doi.org/10.1016/j.carrev.2021.01.016
UR  - http://hdl.handle.net/10044/1/87044
VL  - 34
ER  -
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