TY - JOUR
T1 - Antithrombotic strategies after transcatheter aortic valve implantation
T2 - Insights from a network meta-analysis
AU - Kuno, Toshiki
AU - Takagi, Hisato
AU - Sugiyama, Takehiro
AU - Ando, Tomo
AU - Miyashita, Satoshi
AU - Valentin, Nelson
AU - Shimada, Yuichi J.
AU - Kodaira, Masaki
AU - Numasawa, Yohei
AU - Kanei, Yumiko
AU - Hayashida, Kentaro
AU - Bangalore, Sripal
N1 - Funding Information:
Dr Shimada is supported in part by unrestricted grants from the American Heart Association National Clinical and Population Research Award and Career Development Award, Honjo International Scholarship Foundation, and Korea Institute of Oriental Medicine. Dr Bangalore is supported from Abbott Vascular, National Heart Lung and Blood Institute by research grant. The funding organizations did not have any role in the study design, collection, analysis, or interpretation of data, in writing of the manuscript, or in the decision to submit the article for publication. The researchers were independent from the funding organizations.
Funding Information:
Patients who underwent TAVI had similar all‐cause mortality rates among different antithrombotic strategies except OAC+DAPT. Patients on SAPT had significantly lower bleeding risk than those on DAPT, OAC + SAPT, and OAC + DAPT. Our results suggest SAPT is the preferred regimen when there is no indication for DAPT or OAC. When DAPT or OAC is indicated, DAPT + OAC should be avoided. Funding information Dr Bangalore is supported from Abbott Vascular, National Heart Lung and Blood Institute by research grant.; Dr. Shimada is supported in part by unrestricted grants from the American Heart Association National Clinical and Population Research Award and Career Development Award, Honjo International Scholarship Foundation, and Korea Institute of Oriental Medicine.
Publisher Copyright:
© 2019 Wiley Periodicals, Inc.
PY - 2020/8/1
Y1 - 2020/8/1
N2 - Objectives: We aimed to investigate the efficacy and safety of different antithrombotic strategies in patients undergoing transcatheter aortic valve implantation (TAVI) using network meta-analyses. Background: Meta-analyses comparing single antiplatelet therapy (SAPT) vs. dual antiplatelet therapy (DAPT), ± oral anticoagulant (OAC) was conducted to determine the appropriate post TAVI antithrombotic regimen. However, there was limited direct comparisons across the different therapeutic strategies. Methods: MEDLINE and EMBASE were searched through December 2018 to investigate the efficacy and safety of different antithrombotic strategies (SAPT, DAPT, OAC, OAC + SAPT, and OAC + DAPT) in patients undergoing TAVI. The main outcome were all-cause mortality, major or life-threatening bleeding events, and stroke. Results: Our search identified 3 randomized controlled trials and 10 nonrandomized studies, a total of 20,548 patients who underwent TAVI. All OACs were vitamin K antagonists. There was no significant difference on mortality except that OAC + DAPT had significantly higher rates of mortality compared with others (p <.05, I2 = 0%). SAPT had significantly lower rates of bleeding compared with DAPT, OAC+SAPT, and OAC+DAPT (hazard ratio [HR]: 0.59 [0.46-0.77], p <.001, HR: 0.58 [0.34-0.99], p =.045, HR: 0.41 [0.18-0.93], p =.033, respectively, I2 = 0%). There was no significant difference on stroke among all antithrombotic strategies. Conclusion: Patients who underwent TAVI had similar all-cause mortality rates among different antithrombotic strategies except OAC+DAPT. Patients on SAPT had significantly lower bleeding risk than those on DAPT, OAC + SAPT, and OAC + DAPT. Our results suggest SAPT is the preferred regimen when there is no indication for DAPT or OAC. When DAPT or OAC is indicated, DAPT + OAC should be avoided.
AB - Objectives: We aimed to investigate the efficacy and safety of different antithrombotic strategies in patients undergoing transcatheter aortic valve implantation (TAVI) using network meta-analyses. Background: Meta-analyses comparing single antiplatelet therapy (SAPT) vs. dual antiplatelet therapy (DAPT), ± oral anticoagulant (OAC) was conducted to determine the appropriate post TAVI antithrombotic regimen. However, there was limited direct comparisons across the different therapeutic strategies. Methods: MEDLINE and EMBASE were searched through December 2018 to investigate the efficacy and safety of different antithrombotic strategies (SAPT, DAPT, OAC, OAC + SAPT, and OAC + DAPT) in patients undergoing TAVI. The main outcome were all-cause mortality, major or life-threatening bleeding events, and stroke. Results: Our search identified 3 randomized controlled trials and 10 nonrandomized studies, a total of 20,548 patients who underwent TAVI. All OACs were vitamin K antagonists. There was no significant difference on mortality except that OAC + DAPT had significantly higher rates of mortality compared with others (p <.05, I2 = 0%). SAPT had significantly lower rates of bleeding compared with DAPT, OAC+SAPT, and OAC+DAPT (hazard ratio [HR]: 0.59 [0.46-0.77], p <.001, HR: 0.58 [0.34-0.99], p =.045, HR: 0.41 [0.18-0.93], p =.033, respectively, I2 = 0%). There was no significant difference on stroke among all antithrombotic strategies. Conclusion: Patients who underwent TAVI had similar all-cause mortality rates among different antithrombotic strategies except OAC+DAPT. Patients on SAPT had significantly lower bleeding risk than those on DAPT, OAC + SAPT, and OAC + DAPT. Our results suggest SAPT is the preferred regimen when there is no indication for DAPT or OAC. When DAPT or OAC is indicated, DAPT + OAC should be avoided.
KW - anticoagulant
KW - antiplatelet
KW - antithrombotic
KW - network meta-analysis
KW - transcatheter aortic valve implantation
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U2 - 10.1002/ccd.28498
DO - 10.1002/ccd.28498
M3 - Article
C2 - 31609071
AN - SCOPUS:85074419967
SN - 1522-1946
VL - 96
SP - E177-E186
JO - Catheterization and Cardiovascular Interventions
JF - Catheterization and Cardiovascular Interventions
IS - 2
ER -