Background: Transcatheter aortic valve implantation (TAVI) has undeniably
earned a prestigious post in the quiver of interventional cardiologists against symptomatic
severe aortic stenosis. Cerebrovascular events are listed within the most frequent complications.
Methods: We performed a systematic search of EMBASE, MEDLINE, and the Cochrane
library from inception to March 2016 for the following search terms (transcatheter AND
antiplatelet) OR (transcatheter AND antithrombotic) to retrieve studies of dual antiplatelet
treatment (DAPT) and single antiplatelet treatment (SAPT) in patients after TAVI to study
thrombotic, hemorrhagic and cardiovascular events at 30 days post procedure. From a total
of 208 records 4 studies met inclusion criteria.
Results: In the included studies, 286 patients were enrolled in the DAPT group and 354
patients in the SAPT group. There was no difference in all-cause mortality, cardiovascular mortality, stroke, and
myocardial infraction 30 days post TAVI between DAPT and SAPT. However, patients in the DAPT group had a
significantly increased incidence of lethal and major bleeding at 30 days of follow-up and the incidence of the
combined end-point of stroke, spontaneous MI, all-cause mortality and major bleeding was significantly higher in
the DAPT group in comparison to the SAPT group.
Conclusion: DAPT compared to SAPT in patients after TAVI increases incidence of hemorrhagic events with no
benefits in terms of thrombotic events and cardiovascular mortality. However, these data must be interpreted
cautiously and the choice of DAPT over SAPT must be based on an individual patient characteristic according to
medical practice criteria.