Key result
In post-TAVI patients, OAC plus single antiplatelet therapy increased the risk of all-cause death compared with dual antiplatelet therapy (OR 1.78; 95% CrI 1.15-2.77).
Why the study?
The optimal antithrombotic therapy to balance the risk of thrombosis and bleeding in patients undergoing transcatheter aortic valve implantation is unknown.
Do different antithrombotic regimens (SAPT, DAPT, OAC) affect the risk of all-cause death and major bleeding in patients post-TAVI?
Meta-Analysis (n=6,415)
Do different antithrombotic regimens (SAPT, DAPT, OAC) affect the risk of all-cause death and major bleeding in patients post-TAVI?
Odds Ratio: 1.78 (95% CI 1.15–2.77)
In patients post-TAVI, single antiplatelet therapy (SAPT) appears to provide the optimal balance by reducing major bleeding without increasing all-cause death compared to more intensive antithrombotic regimens.
SAPT may be preferred post-TAVI to balance thrombosis and bleeding; extends prior pairwise meta-analyses with comprehensive network comparisons of regimens.
AIMS: The optimal antithrombotic therapy to balance the risk of thrombosis and bleeding in patients who undergo transcatheter aortic valve implantation (TAVI) is unknown. This systematic review/network meta-analysis of randomized controlled trials (RCTs) aimed to evaluate the efficacy and safety of different oral anticoagulant (OAC) and antiplatelet regimens in patients post-TAVI. METHODS AND RESULTS: MEDLINE, Embase, CENTRAL, and ClinicalTrials.gov were searched from inception to April 2023. Co-primary outcomes were all-cause death and major bleeding. We conducted Bayesian network meta-analyses to compare all interventions simultaneously. For each outcome, we generated odds ratios (ORs) with 95% credible intervals using a random-effects model with informative priors, and ranked interventions based on mean surface under the cumulative ranking curve. We included 11 RCTs (n = 6415), including 1 unpublished RCT. Three trials enrolled patients with an indication for an OAC. Overall risk of bias was low or with some concerns. Median age was 81 years. Median follow-up was 6 months. The combination of OAC plus single antiplatelet therapy (SAPT) increased the risk of all-cause death compared with dual antiplatelet therapy (DAPT) (OR 1.78, 95% credible interval 1.15-2.77). No other comparisons for all-cause death were significantly different. For major bleeding, SAPT reduced the risk compared with DAPT, direct-acting OAC, and OAC + SAPT (OR 0.20-0.40), and DAPT reduced the risk compared with OAC + SAPT. SAPT and DAPT ranked best for all-cause death, while SAPT ranked best for major bleeding. CONCLUSION: In post-TAVI patients, SAPT may provide the optimal balance of reducing thrombotic events while minimizing the risk of bleeding.
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Turgeon et al. (2023) conducted a meta-analysis in Post-transcatheter aortic valve implantation (TAVI) (n=6,415). OAC plus single antiplatelet therapy (SAPT) vs. Dual antiplatelet therapy (DAPT) was evaluated on All-cause death (OR 1.78, 95% CI 1.15-2.77). In post-TAVI patients, OAC plus single antiplatelet therapy increased the risk of all-cause death compared with dual antiplatelet therapy (OR 1.78; 95% CrI 1.15-2.77).
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