Direct oral anticoagulant versus antiplatelet therapy following transcatheter aortic valve replacement in patients without prior or concurrent indication for anticoagulation: A meta‐analysis of randomized studies

Abstract

Introduction:The antithrombotic management following transcatheter aortic valve replacement (TAVR) in patients who do not have a concurrent indication for longterm anticoagulation therapy is an ongoing source of debate.Methods: We performed a systematic review and meta-analysis to compare direct oral anticoagulants (DOACs) versus antiplatelet therapy after TAVR in patients without a concomitant indication for chronic oral anticoagulation. PubMed, Embase, and Cochrane databases were searched. Only randomized controlled trials were included. Risk ratios (RR) with p < 0.05 were considered statistically significant.Results: Three studies were included, with 2922 patients who underwent TAVR, of whom 1463 (50.1%) received DOACs. Patients who received DOACs therapy had significantly higher all-cause mortality (RR: 1.68; 95% confidence intervals [CI]:1.22−2.30; p = 0.001) and non-cardiovascular mortality (RR: 2.33; 95% CI: 1.13−4.80; p = 0.02). The incidence of major bleeding was not significantly different between the groups (5.3% vs. 3.8%; RR: 1.44; 95% CI: 0.90−2.32; p = 0.13). There was no difference between DOACs and antiplatelet therapy in terms of: ischemic stroke (RR: 1.28; 95% CI: 0.76−2.15; p = 0.35) and cardiovascular mortality (RR: 1.36; 95% CI: 0.92−2.03; p = 0.13). Lastly, the DOACs group had a significantly lower risk of valve thrombosis than the antiplatelet group (0.8% vs. 3.2%; RR: 0.27; 95% CI: 0.14−0.51; p < 0.0001). Conclusion:In this meta-analysis of randomized studies comparing DOACs to antiplatelet therapy after TAVR in patients without a concomitant indication for anticoagulation, DOACs were associated with a lower incidence of valve thrombosis

Antitrombotska terapija u bolesnika podvrgnutih transkateterskoj implantaciji aortalnog zaliska

“…Nekoliko radova proučavalo je nastanak SLT-a nakon TAVI zahvata. Zaključeno je da pojava SLT-a nosi tri puta veći rizik od nastanka moždanog udara 27 , a oralni su antikoagulansi najučinkovitiji lijekovi u njezinoj prevenciji [27][28][29] .…”

Bioprosthetic Aortic Valve Thrombosis: Definitions, Clinical Impact, and Management: A State-of-the-Art Review

“…80 Furthermore, a meta-analysis comparing NOACs with antiplatelet therapy after TAVR in patients without an indication for concurrent OAC found a significantly lower risk of valve thrombosis with nonvitamin K antagonist oral anticoagulant therapy; this coincided with higher allcause mortality. 81 Another meta-analysis of 3 randomized trials comprising 2922 patients without an indication for OAC after TAVR showed that NOACs were associated with a higher risk of all-cause mortality and noncardiac mortality at 15 months, primarily driven by a greater number of major or life-threatening bleeding events. 82 Thus, the preponderance of evidence favors single antiplatelet therapy after TAVR in patients without concurrent indications for OAC.…”

Antithrombotic therapy after TAVI: Better alone than with a bad company

“…Thus, OAC use after TAVI had a class III recommendation in the European Guidelines. 2 In this issue of CCI, Moreira et al 4 provide a systematic review and meta-analysis comparing DOACs versus antiplatelet therapy after TAVR in patients without previous indication for OAC. All three precited RCTs were included with a total of 2922 patients, of whom 1463 (50.1%) received DOACs.…”