Monotherapy Bests DAPT After Cardiac Surgery

Despite guideline recommendations, mono-antiplatelet therapy is just as effective as dual-antiplatelet therapy (DAPT) after transcatheter aortic valve implantation (TAVI), according to a new review. Moreover, monotherapy was also associated with a better safety profile.

The researchers from Loyola Medicine came to this conclusion after conducting a meta-analysis of 8 studies, including 2439 individuals, that evaluated DAPT vs monotherapy after TAVI.

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Results showed that at 30 days, individuals taking DAPT were 2.06 times more likely to die, 2.04 time more likely to have a major or life-threatening bleeding event, and 2.15 time more likely to have major vascular complications.

No statistically significant differences in ischemic complications, such as stroke or transient ischemic attack, were observed between the groups.

Among the 5 studies with 6-month follow-up data, major or life-threatening bleeding was more common among individuals taking DAPT.

“These data suggest a safety concern with DAPT and justify further investigation of the optimal antiplatelet therapy regimen after TAVI,” the researchers concluded.

—Amanda Balbi

Reference:

Al Halabi S, Newman J, Farkouh ME, et al. Meta-analysis of studies comparing dual- versus mono-antiplatelet therapy following transcatheter aortic valve replacement. Am J Cardiol. 2018;122(1):141-148. https://doi.org/10.1016/j.amjcard.2018.03.019.

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