Direct Oral Anticoagulants Versus Vitamin K Antagonists in Patients With Atrial Fibrillation After TAVR

Kawashima, Hideyuki; Watanabe, Yusuke; Hioki, Hirofumi; Kozuma, Ken; Kataoka, Akihisa; Nakashima, Mitsuyoshi; Nagura, Fukuko; Nara, Yugo; Yashima, Fumiaki; Tada, Norio; Naganuma, Toru; Yamawaki, Masahiro; Yamanaka, Futoshi; Shirai, Shinichi; Mizutani, Kazuki; Tabata, Minoru; Ueno, Hiroshi; Takagi, Kensuke; Yamamoto, Masanori; Hayashida, Kentaro

doi:10.1016/j.jcin.2020.09.013

Cited by 68 publications

(69 citation statements)

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“…Four studies compared outcome with VKA versus DOAC among patients with indication for longterm anticoagulation. 6,[9][10][11] Here the ORs for bleeding and stroke were 0.78 [95% CI: 0.24-2.49], p ¼ 0.68, and 0.70 [95% CI: 0.34-1.43], p ¼ 0.33, respectively (►Fig. 7C).…”

Section: Analyses According To Indication For Oacmentioning

confidence: 99%

“…In two investigations where patients had indication for OAC,7,17 a strategy of OAC alone was associated with similar rates of stroke (OR 0.92 [95% CI 0.41-2.05], p=0.83) and reduced occurrence of any bleeding events (OR 0.49 [95% CI 0.37-0.66], p<0.01) (Figure7, Panel B) vs OAC+SAPT. Four studies compared outcome with VKA vs DOAC among patients with indication for long-term anticoagulation 6,[9][10][11]. Here the odds ratios for bleeding and stroke were 0.78 [95% CI 0.24-2.49], p=0.68 and 0.70 [95% CI 0.34-1.43], p=0.33, respectively (Figure…”

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confidence: 98%

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Safety and Efficacy of Different Antithrombotic Strategies after Transcatheter Aortic Valve Implantation: A Network Meta-Analysis

et al. 2021

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Background The optimal pharmacological therapy after transcatheter aortic valve implantation (TAVI) remains uncertain. We compared efficacy and safety of various antiplatelet and anticoagulant approaches after TAVI by a network meta-analysis. Methods A total of 14 studies (both observational and randomized) were considered, with 24,119 patients included. Primary safety endpoint was the incidence of any bleeding complications during follow-up. Secondary safety endpoint was major bleeding. Efficacy endpoints were stroke, myocardial infarction, and cardiovascular mortality. A frequentist network meta-analysis was conducted with a random-effects model. The following strategies were compared: dual antiplatelet therapy (DAPT), single antiplatelet therapy (SAPT), oral anticoagulation (OAC), and OAC + SAPT. The mean follow-up was 15 months. Results In comparison to DAPT, SAPT was associated with a 44% risk reduction of any bleeding (odds ratio [OR]: 0.56 [95% confidence interval, CI: 0.39–0.80]). SAPT was ranked as the safest strategy for the prevention of any bleeding (p-score: 0.704), followed by OAC alone (p-score: 0.476) and DAPT (p-score: 0.437). Consistent results were observed for major bleeding. The incidence of cardiovascular death and secondary ischemic endpoints did not differ among the tested antithrombotic approaches. In patients with indication for long-term anticoagulation, OAC alone showed similar rates of stroke (OR: 0.92 [95% CI: 0.41–2.05], p = 0.83) and reduced occurrence of any bleeding (OR: 0.49 [95% CI: 0.37–0.66], p < 0.01) versus OAC + SAPT. Conclusion The present network meta-analysis supports after TAVI the use of SAPT in patients without indication for OAC and OAC alone in those needing long-term anticoagulation.

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Section: Analyses According To Indication For Oacmentioning

confidence: 99%

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Safety and Efficacy of Different Antithrombotic Strategies after Transcatheter Aortic Valve Implantation: A Network Meta-Analysis

et al. 2021

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“…After reading full-text, 33 records were excluded for speci c reasons listed in Fig. 1 Finally, 12 studies with 6,943 patients in total met the inclusion criteria, which included 2 RCTs [3,15], 1 nonrandomized clinical trial [16] and 9 cohort studies [17][18][19][20][21][22][23][24][25].…”

Section: Selection Of Studies and Evaluation Of Qualitymentioning

confidence: 99%

Efficacy and Safety of Antithrombotic Therapy With Non-Vitamin K Antagonist Oral Anticoagulants After Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis

et al. 2021

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Purpose: We performed a meta-analysis to compare the efficacy and safety of antithrombotic therapy with non-vitamin K antagonist oral anticoagulants (NOACs) versus standard care in patients after successful transcatheter aortic valve replacement (TAVR).Methods: A systematic search of PubMed, Cochrane Central Register of Controlled Trials, EMBASE databases and ClinicalTrials.gov Website (through Oct 21, 2020) was performed. Risk ratio (RR) with 95% confidence intervals (CI) for all outcomes were calculated using random-effects models.Results: Twelve studies comprising 6,943 patients were included (5,299 had indications for OAC while 1,644 didn’t). No significant differences were found between NOACs and the standard care in all stroke, a composite endpoint and major/life-threatening bleeding. NOACs were associated lower all-cause mortality than VKAs for post-TAVR patients with indications for OAC after more than 1-year follow-up (RR = 0.64, 95% CI: [0.42, 0.96], p = 0.03) while NOACs were poorer than APT for patients without indications for OAC (RR = 1.66, 95% CI: [1.12, 2.45], p = 0.01). As for the impact to prevent valve thrombosis, NOACs and VKAs were not significantly different for patients with indications for OAC (RR = 0.66, 95% CI: [0.24, 1.84], p = 0.43) while NOACs were better than APT for patients without indications for OAC (RR = 0.19, 95% CI: [0.04, 0.83], p = 0.03).Conclusions: For patients with indications for OAC, post-TAVR antithrombotic therapy with NOACs were more favorable due to its lower all-cause mortality after more than 1-year follow-up. For those without indications for OAC, NOACs were poorer due to its higher all-cause mortality.

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“…Dies gilt sowohl für Patienten mit als auch ohne begleitende sonstige Indikation zur oralen Antikoagulation. Für erstere Gruppe wurde im OCEAN-Register der Einfluss von direkten oralen Antikoagulanzien mit Vitamin-K-Antagonisten verglichen [13]. Die Patienten mit Vorhofflimmern waren mit 84 Jahren relativ alt.…”

Section: Medikamentöse Begleittherapieunclassified

“…Das Schlaganfallrisiko war bei einem Hier steht eine Anzeige. So eindeutig diese Zahlen auch zu sein scheinen, so sehr muss allerdings in diesem Fall auf das vergleichsweise kleine Kollektiv (403 Patienten) hingewiesen werden [13].…”

Section: Medikamentöse Begleittherapieunclassified

Aortenklappenstenose im Jahr 2020

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Möllmann

2021

Kardiologe

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Direct Oral Anticoagulants Versus Vitamin K Antagonists in Patients With Atrial Fibrillation After TAVR

Cited by 68 publications

References 23 publications

Safety and Efficacy of Different Antithrombotic Strategies after Transcatheter Aortic Valve Implantation: A Network Meta-Analysis

Safety and Efficacy of Different Antithrombotic Strategies after Transcatheter Aortic Valve Implantation: A Network Meta-Analysis

Efficacy and Safety of Antithrombotic Therapy With Non-Vitamin K Antagonist Oral Anticoagulants After Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis

Aortenklappenstenose im Jahr 2020

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