BACKGROUND

There is ambiguity on antiplatelet therapy for post-transcatheter aortic valve replacement (TAVR) patients for stroke prevention, but dual antiplatelet therapy (DAPT) is routinely started despite lack of data on effectiveness and bleeding safety of DAPT versus single antiplatelet therapy (SAPT). This study aims to determine the effectiveness of DAPT versus SAPT in stroke prevention and assess bleeding safety.

METHODS

A systematic search was done for randomized clinical trials involving DAPT and SAPT in patients who underwent TAVR. The primary outcome was stroke after 1 year of either DAPT and SAPT and life-threatening bleeding. Secondary end points included all-cause mortality. Trials were identified through systematic searches on the following databases (November 2019): Cochrane, MEDLINE, and Google Scholar and ClinicalTrials.gov and World Health Organization International Clinical Trials Registry Platform. Risk ratio was used for dichotomous outcomes. Heterogeneity among the studies for the meta-analysis was detected using a χ2 test (0.01 level of significance). Risk-of-bias assessment was done.

RESULTS

There is a lower incidence of stroke in patients on DAPT, but with a higher incidence of life-threatening bleeding and major bleeding. There is also a lower incidence of all-cause mortality in SAPT. The statistical power of this meta-analysis is low due to small population size.

CONCLUSION

Single antiplatelet therapy is comparable to DAPT in preventing stroke with the added benefit of a lower incidence of life-threatening and major bleeding and a lower incidence of all-cause mortality.

Hemorrhage ; bleeding ; mortality ; Myocardial Infarction ; Stroke ; Transcatheter Aortic Valve Replacement ; transcatheter aortic valve implantation

Trimetazidine as adjunctive therapy in cardioischemic patients has shown improvement in angina and left ventricular ejection fraction, but with conflicting evidence on hard clinical outcomes. This meta-analysis aims to compare the efficacy of trimetazidine versus placebo in reducing cardiac mortality and major adverse cardiac events (MACEs) in coronary artery disease patients after reperfusion strategies, whether percutaneous coronary intervention or thrombolysis. The primary outcomes examined were cardiac mortality and combined MACEs; secondary outcomes were repeat revascularization, heart failure after reperfusion, stent restenosis, recurrence of angina, and reinfarction. Trimetazidine in comparison to placebo was associated with lower cardiac mortality and combined MACEs, but results were not significant. Among secondary outcomes, only stent restenosis was significantly reduced (risk ratio, 0.53; 95% confidence interval, 0.34-0.83; P = 0.006). Further trials should be conducted with more standard dosing regimens, duration of therapy, and similar severities of ischemic disease.