OR3-3 | Meta-Analysis Comparison of Post Tavr Antithrombotic Therapy Regimens

The optimal antithrombotic therapy after transcatheter aortic valve replacement (TAVR), in patients with and without indication for anticoagulation (AC), remains a topic of debate due to competitive risks of bleeding and valve thrombosis. Current societal guidelines recommend use of lifelong aspirin (ASA) with or without clopidogrel or warfarin (VKA) for 3-6 months based on bleeding risk post TAVR. The role of direct oral anticoagulant (DOAC) in this setting remains unclear. We searched electronic databases for randomized controlled trials comparing DOAC to antiplatelets or warfarin post TAVR. We performed a random effect meta-analysis and trial sequential analysis (TSA) was performed to assess the relevant outcomes. Five studies/sub-studies were included in the analysis. DOAC use was associated with higher mortality compared to antiplatelet agents in patients with no indication for AC post TAVR however no difference was found in patients with indication for AC (Figure 1A). There was no difference in Valve Academic Research Consortium (VARC) life threatening/disabling/major bleeding and valve thrombosis between DOAC versus antiplatelet and VKA (Figure1B). In post-TAVR patients with an indication for AC and at low bleeding risk, there may be a role for treatment with DOAC as opposed to VKA. More randomized data is needed to confirm our results as well as analyze additional in-hospital and long-term outcomes.