Antithrombotic Strategy After Transcatheter Aortic Valve Replacement: A Network Meta-Analysis. Curr Probl Cardiol 2022 Dec;47(12):101348
Date
08/10/2022Pubmed ID
35944749DOI
10.1016/j.cpcardiol.2022.101348Scopus ID
2-s2.0-85138778528 (requires institutional sign-in at Scopus site)Abstract
The ideal antithrombotic therapy post transcatheter aortic valve replacement (TAVR) remains uncertain. We performed a network meta-analysis of RCTs to report the outcomes with various antithrombotic strategies to determine the optimal therapy. A systematic search of the PubMed/Medline and Cochrane databases was performed through January 6, 2022. The primary outcome was stroke and the secondary outcomes were major/life-threatening bleeding, myocardial infarction, all-cause mortality, and cardiac mortality. A network meta-analysis was conducted with a random-effects model. All analysis was carried out using R version 4.0.3. Six RCTs were included in the final analysis. SAPT when compared with DAPT was associated with a reduced risk of major or life-threatening bleeding [OR: 0.42; 95% CI: 0.25-0.70]. Other antithrombotic strategies were associated with similar odds of major and life-threatening bleeding post TAVR compared with DAPT. There was no difference in the incidence of stroke, myocardial infarction, all-cause and cardiac mortality between the various antithrombotic strategies post TAVR. The present analysis reported SAPT as the preferred antithrombotic regimen post TAVR compared with other regimens in patients who do not have other indications for anticoagulation. Additional studies such as ADAPT-TAVR, CLOE and ATLANTIS trials will further add to our understanding of the adequate antithrombotic regimen post TAVR in patients with otherwise no indication for anticoagulation.
Author List
Mahalwar G, Kumar A, Majmundar M, Adebolu O, Yendamuri R, Lao N, Barve N, Kreutz RP, Reed GW, Puri R, Dani SS, Kalra AAuthor
Nicole Mae Lao MD Assistant Professor in the Medicine department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AnticoagulantsAortic Valve
Aortic Valve Stenosis
Fibrinolytic Agents
Hemorrhage
Humans
Myocardial Infarction
Network Meta-Analysis
Platelet Aggregation Inhibitors
Randomized Controlled Trials as Topic
Risk Factors
Stroke
Transcatheter Aortic Valve Replacement
Treatment Outcome