Antithrombotic therapy in patients after TAVR: an up-date meta-analysis

Abstract

Background: Antiplatelet and anticoagulation therapy can reduce the risk of thrombosis in patients after TAVR, but there is no consensus on the risk of bleeding, and current antithrombotic regimens for patients after TAVR are based on empirical treatment with no expert consensus. We performed a meta-analysis to summarize the efficacy and safety of mono-antiplatelet, mono-anticoagulation, and dual-antiplatelet therapy in patients after TAVR alone and NOACs, VKA, and OAC plus SAPT for patients with TAVR combined with AF. Methods: We searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials, and then performed a systematic review of all randomized controlled trials and cohort studies. Results: In patients with TAVR without an indication for oral anticoagulants, SAPT and DAPT did not differ significantly in all-cause mortality, stroke events in the opposite direction, while SAPT was associated with a lower bleeding rate (OR: 1.79, 95% CI: 1.04-3.09, p = 0.04), and OAC and SAPT, although not different in each endpoint event, were not recommended due to their safety Use. In patients with an indication for oral anticoagulation, NOACs did not differ significantly in all-cause mortality, bleeding and embolic events compared with VKA. OAC + SAPT significantly increased the risk of bleeding compared with OAC alone (OR: 1.33, 95% CI: 1.14-1.55, p = 0.0003). Conclusions:SAPT treatment reduces the risk of bleeding and does not increase the risk of mortality or stroke in patients with TAVR without an indication for oral anticoagulants; NOACs is the preferred option for patients with TAVR combined with AF with an indication for oral anticoagulants and is not recommended to be added to antiplatelet drugs.