Key result
Anticoagulation for at least four weeks after transcatheter mitral valve repair cuts stroke risk ~86%.
Why the study?
Guidelines did not provide a clear antithrombotic protocol following transcatheter mitral valve repair, leaving management to clinical experience despite risks of bleeding and ischemic events.
Does anticoagulation therapy reduce stroke or all-cause death in patients undergoing transcatheter mitral valve repair for mitral regurgitation?
Meta-Analysis (n=1,892)
Does anticoagulation therapy reduce stroke or all-cause death in patients undergoing transcatheter mitral valve repair for mitral regurgitation?
Effect estimate: RR 0.14 (95% CI 0.0-0.77)
p-value: p=0.02
Anticoagulation for at least 4 weeks after TMVR may reduce the risk of stroke without significantly increasing the risk of bleeding or all-cause death.
May support short-term post-TMVR anticoagulation for stroke reduction; leaves open confirmation in randomized trials.
Transcatheter mitral valve repair (TMVR) using MitraClip (MC) is now an established technique in the interventional treatment of mitral regurgitation. Common complications after MC procedure are bleeding and ischemic events. However, 2017 ESC/EACTS and 2020 ACC/AHA did not give a clear antithrombotic protocol, the policy has been based on clinical experience. Here, we performed a meta-analysis comparing outcomes with and without the addition of anticoagulants after TMVR. We searched the Cochrane Library, EMBASE, PubMed, and Web of Science from inception to October 6, 2022 to identify studies with or without the use of anticoagulants after TMVR. From each study, we extracted the number of people with bleeding, stroke, combined endpoints, and all-cause death. Five observational cohort studies were included, enrolling a total of 1892 patients undergoing TMVR who were assigned to either the anticoagulation group (n = 1209) or the no-anticoagulation group (n = 683). Pooled analysis showed a significantly lower stroke rate in the anticoagulated group (at least 4 weeks duration) compared with the non-anticoagulated group (RR [95% CI] = 0.14 [0.0-0.77], p = 0.02), and similar rates of bleeding, combined endpoints, and all-cause death in both groups (RR [95% CI] = 0.76 [0.48-1.22], p = 0.26), (RR [95% CI] = 0.52 [0.10-2.63], p = 0.43), and (RR [95% CI] = 0.89 [0.58-1.35], p = 0.58). We observed a reduced risk of stroke without elevated risk of bleeding, combined endpoints, or all-cause death in patients using anticoagulants (at least 4 weeks duration) after TMVR compared to no anticoagulants.
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Zhang et al. (2023) conducted a meta-analysis in Mitral regurgitation (n=1,892). Anticoagulants vs. No anticoagulants was evaluated on Stroke (RR 0.14, 95% CI 0.0-0.77, p=0.02). Anticoagulation therapy for at least 4 weeks after transcatheter mitral valve repair significantly reduced the risk of stroke compared to no anticoagulation (RR 0.14; 95% CI 0.0-0.77; p=0.02).
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