Efficacy and outcomes of antiplatelet therapy versus oral anticoagulants in patients undergoing transcatheter aortic valve replacement: a systematic review and meta-analysis

Abstract

Background: Recent guidelines suggest that antiplatelet therapy (APT) is the standard of care in the absence of long-term oral anticoagulation (OAC) indications in patients post-transcatheter aortic valve replacement (TAVR). The superiority of one method over the other remains controversial. Materials and methods: Several databases, including MEDLINE, Google Scholar, and EMBASE, were electronically searched. The primary endpoint was the all-cause mortality (ACM) rate. Secondary endpoints included cardiovascular death, myocardial infarction (MI), stroke/TIA, haemorrhagic stroke, bleeding events, systemic embolism, and valve thrombosis in post-TAVR patients receiving APT and oral anticoagulants (OACs). Forest plots were generated using Review Manager version 5.4, with a p value less than 0.05 indicating statistical significance. Subgroup analysis was performed to explore potential sources of heterogeneity. Results: Twelve studies were selected. No significant differences were observed in APT and OAC group for ACM [risk ratio (RR): 0.67; 95% CI:0.45–1.01; P=0.05], cardiovascular death [RR:0.91; 95% CI:0.73–1.14; P=0.42], MI [RR:1.69; 95% CI:0.43–6.72; P=0.46], Stroke/TIA [RR:0.79; 95% CI:0.58–1.06; P=0.12], ischaemic stroke [RR:0.83; 95% CI:0.50–1.37; P=0.47], haemorrhagic stroke [RR:1.08; 95% CI: 0.23–5.15; P=0.92], major bleeding [RR:0.79; 95% CI:0.51–1.21; P=0.28], minor bleeding [RR:1.09; 95% CI: 0.80–1.47; P=0.58], life-threatening bleeding [RR:0.85; 95% CI:0.55–1.30; P=0.45], any bleeding [RR:0.98; 95% CI:0.83–1.15; P=0.78], and systemic embolism [RR:0.87; 95% CI:0.44–1.70; P=0.68]. The risk of valve thrombosis was higher in patients receiving APT than in those receiving OAC [RR:2.61; 95% CI:1.56–4.36; P =0.0002]. Conclusions: Although the risk of valve thrombosis increased in patients receiving APT, the risk of other endpoints was comparable between the two groups.