Post-Transcatheter Aortic Valve Replacement Antithrombotic Treatment in Nonindicated Patients

Figures

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  Central Illustration. Post-Transcatheter Aortic Valve Replacement Antithrombotic Treatment in Patients Without an Indication for Anticoagulation This central illustration presents a network meta-analysis of 8 RCTs and 3 PSM cohorts (N = 5,821) evaluating the effectiveness and safety of various antithrombotic regimens following TAVR. P scores for all-cause mortality, cardiovascular mortality, stroke, myocardial infarction, major bleeding, and total bleeding are shown for each treatment regimen. A P score closer to 1.00 indicates greater effectiveness and fewer adverse events. DOAC = direct oral anticoagulant; PSM = propensity score-matched; RCT = randomized controlled trial; other abbreviations as in Figures 2, 3, and 5.

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  Figure 1. PRISMA Flowchart This flowchart depicts the study selection process following the PRISMA 2020 guidelines, outlining the number of studies identified, screened, assessed for eligibility, and included in the final analysis. PRISMA = Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

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  Figure 2. Network Plot of Included Studies This network plot illustrates the comparative evidence for antithrombotic treatment regimens in relation to all-cause mortality. Nodes (circles) represent different treatment strategies, with larger nodes indicating a greater number of patients assigned to that intervention. Edges (lines) denote direct comparisons between treatments, with thicker lines corresponding to a higher number of studies evaluating the respective comparison. DAPT = dual antiplatelet therapy; OAC = oral anticoagulant; SAPT = single antiplatelet therapy.

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  Figure 3. Pairwise Network Meta-Analysis of Primary Efficacy and Safety Outcomes This figure presents a pairwise network meta-analysis comparing SAPT, DAPT, OAC, and OAC + SAPT for all-cause mortality, major or life-threatening bleeding, and total bleeding. ORs with 95% CIs are displayed for each comparison. OAC + SAPT = oral anticoagulant plus single antiplatelet therapy; other abbreviations as in Figure 2.

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  Figure 4. Pairwise Network Meta-Analysis of Secondary Efficacy and Safety Outcomes This figure presents a pairwise network meta-analysis comparing SAPT, DAPT, OAC, and OAC + SAPT for cardiovascular mortality, stroke, and myocardial infarction. ORs with 95% CIs are displayed for each comparison. Abbreviations as in Figures 2 and 3.

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  Figure 5. Bubble Plot of Meta-Regression Analysis on Chronic Obstructive Pulmonary Disease This bubble plot illustrates the meta-regression analysis assessing the modifying effect of COPD on the risk of major or life-threatening bleeding in patients receiving SAPT vs DAPT following TAVR. The regression line represents the relationship between COPD prevalence and the OR for major or life-threatening bleeding with SAPT compared with DAPT, while the bubble size corresponds to the study's weight in the analysis. COPD = chronic obstructive pulmonary disease; TAVR = transcatheter aortic valve replacement; other abbreviations as in Figure 2.