After transcatheter aortic valve replacement (TAVR), ischemic/embolic complications and bleeding remain important because it correlates with mortality. The optimal antithrombotic regimen after successful TAVR remains unclear. This study compared the efficacy and safety of single antiplatelet therapy (SAPT) versus dual antiplatelet therapy (DAPT) among post-TAVR patients.

Extensive search of PubMed, MEDLINE, Cochrane, and Ovid was done for articles published until November 20, 2020. Studies were limited to randomized controlled trials. Outcome measures include stroke, myocardial infarction (MI), all-cause mortality, and major bleeding. Two reviewers independently reviewed the studies. Results were gathered from published articles, journals, and clinical trials. Studies were critically appraised with regard to methods of minimizing bias. All four studies included received a quality scale for meta-analysis overall score of not less than B. Statistical analysis was done using Review Manager V5.4.

Four randomized controlled trials with 1086 patients were included in this meta-analysis. Overall, the risk of stroke (odds ratio [OR], 0.94 [0.54-1.64]), MI (OR, 0.50 [0.18-1.40]), and overall mortality (OR, 1.01 [0.65-1.57]) did not differ significantly between DAPT and SAPT. There was increased risk of bleeding noted with DAPT, thus favoring SAPT (OR, 0.44 [0.30- 0.65]).

Among patients who underwent TAVR, DAPT compared with SAPT had similar rates of stroke, MI, and death. Because of lower rates of bleeding, we recommend using single antiplatelet therapy after TAVR.