Efficacy and safety of continuation vs. interruption of anticoagulation during transcatheter aortic valve implantation: A systematic review and meta-analysis

BACKGROUND: The appropriate periprocedural management of oral anticoagulation in transcatheter aortic valve implantation (TAVI) patients who require long-term anticoagulation remains controversial. PURPOSE: This systematic review and meta-analysis compare the efficacy and safety of periprocedural continuation versus interruption of anticoagulation in patients undergoing TAVI with an indication for long-term anticoagulation. METHODS: We searched PubMed, Embase, and Cochrane Central databases to identify relevant articles. We included both observational and randomized controlled trials. Data were analysed using random-effects model to calculate the odds ratio (OR) with 95% confidence intervals (CIs). A p < .05 was considered statistically significant. RESULTS: Four studies comprising 3,144 patients, with anticoagulation continued in 1,500 (47.7%) patients were included. There were no difference between periprocedural continuation and interruption of anticoagulation in the incidence of composite outcomes (OR: 0.84; 95% CI: 0.64-1.10; p = .19), major bleeding (OR: 0.98; 95% CI: 0.57-1.68; p = .95), major vascular complications (OR: 0.93; 95% CI: 0.72-1.20; p = .60), and myocardial infarction (MI) (OR: 0.60; 95% CI: 0.20-1.77; p = .36). However, the incidence of stroke was significantly lower in the continuation group (OR: 0.61; 95% CI: 0.39-0.94; p = .03). The incidence of blood transfusion was not significantly different between the continuation and interruption groups (OR: 0.86; 95% CI: 0.42-1.77; p = .68). CONCLUSIONS: In this meta-analysis comparing periprocedural continuation of anticoagulation to interruption of therapy in patients undergoing TAVI with concomitant indications for long-term anticoagulation, continuation of anticoagulation was associated with a lower incidence of stroke without increasing the risk of bleeding. These findings suggest a potentially favourable safety profile in favour of continuation of anticoagulant therapy, they should be interpreted with caution and validated in larger and well-designed randomised trials. The review protocol was prospectively registered with the International Prospective Register of Systematic Reviews (PROSPERO), registration number (CRD42024607149).