Continued Versus Interrupted Oral Anticoagulation During Transcatheter Aortic Valve Implantation: A Systematic Review and Meta-Analysis

Given the lack of evidence and guideline-based recommendations on the best preoperative oral anticoagulation (OAC) management strategies for transcatheter aortic valve implantation (TAVI), this study aims to compare continued oral anticoagulation (cOAC) versus interrupted oral anticoagulation (iOAC) strategies. We conducted a comprehensive search across PubMed, Embase, Cochrane Central, and ClinicalTrials.gov from inception till February 2025 for studies comparing periprocedural cOAC or iOAC in patients undergoing TAVI. Outcomes were analyzed using a random-effects model to pool odds ratios (ORs) with 95% confidence intervals (CIs). Four studies, comprising a total of 3117 patients, were included in the final analysis. The early (30-day) safety outcome and composite ischemic events were comparable between the approaches. There was no significant difference between cOAC and iOAC in terms of any bleeding, major bleeding, or life-threatening bleeding. However, cOAC was associated with a slightly higher incidence of minor bleeding events (OR: 1.40, 95% CI: 1.02–1.93, P = 0.04). Additionally, major vascular complications, all-cause mortality, cardiac-specific mortality, stroke, transient ischemic attack, myocardial infarction, and length of hospital stay were comparable between the 2 strategies. Both cOAC and iOAC approaches demonstrated comparable outcomes, with cOAC being associated with a slightly higher incidence of minor bleeding events.