Key result
Continued oral anticoagulation during TAVR shows comparable mortality risk to interrupted anticoagulation.
Why the study?
A substantial number of patients undergoing TAVR require long-term OAC, but whether continuing oral anticoagulation periprocedurally is as safe and effective as interrupting it remained unclear.
Does continued oral anticoagulation periprocedurally during TAVR maintain safety and efficacy compared to interrupted oral anticoagulation in patients with atrial fibrillation?
Meta-Analysis (n=2,962)
Does continued oral anticoagulation periprocedurally during TAVR maintain safety and efficacy compared to interrupted oral anticoagulation in patients with atrial fibrillation?
Continuing oral anticoagulation periprocedurally during TAVR is a viable and safe option with comparable bleeding, stroke, and mortality risks to interrupting anticoagulation.
INTRODUCTION: A substantial number of patients undergoing transcatheter aortic valve replacement (TAVR) require long-term oral anticoagulants (OAC) owing to comorbidities. This study examined whether continuing oral anticoagulation periprocedurally during TAVR is as safe and effective as interrupting it. METHODS: A systematic search of the major databases was performed to identify relevant studies. Effect estimates were calculated using risk ratios (RR) and 95% CIs by pooling the data using the inverse-variance random effects model. Statistical significance was set at P < 0.05. RESULTS: Four studies were included, with 2962 patients undergoing TAVR with continued OAC (n = 1318) and interrupted OAC (n = 1644). The pooled analysis demonstrated that TAVR with continued OAC had comparable risks for all-cause mortality (RR: 0.91; 95% CI, 0.62-1.34; P = 0.64), cardiovascular mortality (RR: 0.89; 95% CI, 0.43-1.84; P = 0.76), stroke (RR: 0.67; 95% CI, 0.42-1.08; P = 0.09), closure device failure (RR: 0.86; 95% CI, 0.47-1.59; P = 0.64), major/life-threatening bleeding (RR: 0.93; 95% CI, 0.74-1.15; P = 0.49), and major vascular complications (RR: 0.97; 95% CI, 0.79-1.20; P = 0.80) compared with TAVR with interrupted OAC. CONCLUSIONS: In patients undergoing TAVR, continued OAC showed comparable safety and efficacy with interrupted OAC. These findings demonstrate that continuing OAC in the periprocedural period may be a viable option in patients with atrial fibrillation because of comorbidities requiring anticoagulants.
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Jain et al. (2025) conducted a meta-analysis in Transcatheter aortic valve replacement (TAVR) in patients requiring long-term oral anticoagulants (n=2,962). Continued oral anticoagulation vs. Interrupted oral anticoagulation was evaluated on All-cause mortality (RR 0.91, 95% CI 0.62-1.34, p=0.64). Continued periprocedural oral anticoagulation during TAVR had comparable risks for all-cause mortality compared with interrupted anticoagulation (RR 0.91; 95% CI 0.62-1.34; P=0.64).
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