Antithrombotic strategies after transcatheter aortic valve implantation: Insights from a network meta-analysis

Toshiki Kuno, Hisato Takagi, Takehiro Sugiyama, Tomo Ando, Satoshi Miyashita, Nelson Valentin, Yuichi J. Shimada, Masaki Kodaira, Yohei Numasawa, Yumiko Kanei, Kentaro Hayashida, Sripal Bangalore

Research output: Contribution to journalArticlepeer-review

10 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)E177-E186
JournalCatheterization and Cardiovascular Interventions
Volume96
Issue number2
DOIs
Publication statusPublished - 2020 Aug 1
Externally publishedYes

Keywords

  • anticoagulant
  • antiplatelet
  • antithrombotic
  • network meta-analysis
  • transcatheter aortic valve implantation

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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