Efficacy and safety of antithrombotic therapy with non-vitamin K antagonist oral anticoagulants after transcatheter aortic valve replacement: a systematic review and meta-analysis

Qing An; Shuwen Su; Yan Tu; Lingfeng Gao; Gaopeng Xian; Yujia Bai; Qiong Zhan; Xingbo Xu; Dingli Xu; Qingchun Zeng

doi:10.1177/20406223211056730

Efficacy and safety of antithrombotic therapy with non-vitamin K antagonist oral anticoagulants after transcatheter aortic valve replacement: a systematic review and meta-analysis

Ther Adv Chronic Dis. 2021 Nov 15:12:20406223211056730. doi: 10.1177/20406223211056730. eCollection 2021.

Authors

Qing An¹, Shuwen Su², Yan Tu¹, Lingfeng Gao², Gaopeng Xian², Yujia Bai², Qiong Zhan², Xingbo Xu³, Dingli Xu⁴, Qingchun Zeng⁴

Affiliations

¹ State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital, First Clinical Medical College, Southern Medical University, Guangzhou, China.
² State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital, First Clinical Medical College, Southern Medical University, Guangzhou, China; Guangdong Provincial Key Laboratory of Shock and Microcirculation, Southern Medical University, Guangzhou, China; Bioland Laboratory (Guangzhou Regenerative Medicine and Health Guangdong Laboratory), Guangzhou, China.
³ Department of Cardiology and Pneumology, University Medical Center of Göttingen, Georg-August-University, Göttingen, Germany.
⁴ State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital, First Clinical Medical College, Southern Medical University, 1838 Northern Guangzhou Avenue, Guangzhou, 510515, China.

Abstract

Objective: A meta-analysis was performed 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, and EMBASE databases and ClinicalTrials.gov website (through 21 October 2020) was performed. Risk ratios (RRs) with 95% confidence intervals (CIs) for all outcomes were calculated using random-effects models.

Results: Twelve studies (two studies were randomized controlled trials) comprising 6943 patients were included (5299 had indications for oral anticoagulation (OAC) and 1644 had none). No significant differences were found between NOACs and the standard care in the incidences of all stroke, a composite endpoint, and major/life-threatening bleeding. NOACs were associated with lower all-cause mortality than vitamin K antagonists (VKAs) in post-TAVR patients with indications for OAC after more than 1 year of follow-up [RR = 0.64; 95% CI, (0.42, 0.96); p = 0.03], whereas NOACs exhibited poor outcomes than antiplatelet therapy (APT) in patients without indications for OAC [RR = 1.66; 95% CI, (1.12, 2.45); p = 0.01]. In the prevention of valve thrombosis, NOACs and VKAs were not significantly different in patients with indications for OAC [RR = 0.66; 95% CI, (0.24, 1.84); p = 0.43], whereas NOACs were better than APT in patients without indications for OAC [RR = 0.19; 95% CI, (0.04, 0.83); p = 0.03].

Conclusions: In patients with indications for OAC, post-TAVR antithrombotic therapy with NOACs was more favorable due to its lower all-cause mortality after more than 1 year of follow-up. In those without indications for OAC, NOACs presented poorer outcomes due to its higher all-cause mortality.

Keywords: APT; NOACs; TAVR; VKAs; meta-analysis.