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

Abstract

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.

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

“…A previous meta‐analysis found that DOACs, when compared to vitamin K antagonists (VKA), reduced all‐cause mortality after TAVR in patients with an underlying indication for anticoagulation therapy 13 . However, in patients who undergo TAVR without a concomitant indication for anticoagulation, there is no consensus on whether to administer DOACs or antiplatelet therapy to patients.…”