January 1, 2022Clinical and Applied Thrombosis/HemostasisOpen Access

Efficacy and Safety of NOACs Compared With VKAs for Patients With Atrial Fibrillation After Transcatheter Aortic Valve Implantation: A System Review and Meta-Analysis

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Why the study?

Evidence regarding the efficacy and safety of NOACs versus VKAs after TAVI in patients with AF is very rare.

Do NOACs improve clinical outcomes and safety compared to VKAs in patients with atrial fibrillation after transcatheter aortic valve implantation?

Structured PICO

Do NOACs improve clinical outcomes and safety compared to VKAs in patients with atrial fibrillation after transcatheter aortic valve implantation?

Population

27,107 patients with atrial fibrillation (AF) after transcatheter aortic valve implantation (TAVI) pooled from 11 studies

Intervention

Novel oral anticoagulants (NOACs) as a class

Comparator

Vitamin K antagonists (VKAs)

Outcome

All-cause mortality and strokehard clinical

In patients with atrial fibrillation undergoing TAVI, NOACs appear to offer similar efficacy for stroke prevention and mortality as VKAs, but with a significantly lower risk of bleeding and intracranial hemorrhage.

Implication

Supports preferring NOACs over VKAs in AF after TAVI to reduce bleeding without efficacy loss; extends broader AF evidence to this population.

Abstract

Novel oral anticoagulants (NOACs) are preferentially recommended in patients with nonvalvular atrial fibrillation (AF) for stroke prevention over vitamin K antagonists (VKAs). However, the evidence regarding the efficacy and safety of NOACs versus VKAs after transcatheter aortic valve implantation (TAVI) in patients with AF is very rare. Pubmed, Embase, Web of science, and Cochrane Databases were searched for eligible studies published before May 19, 2022. A total of 11 studies were included in this meta-analysis involving 27 107 patients. Regarding primary outcomes, there were no differences between NOACs and VKAs in all-cause mortality ( RR: 0.84, 95% CI: (0.69, 1.02)) and stroke ( RR: 1.00, 95% CI: (0.85, 1.19)). With respect to secondary outcomes, NOACs were associated with reduced incidence of bleeding ( RR: 0.77, 95% CI: (0.71, 0.83)) and intracranial bleeding ( RR: 0.57, 95% CI: (0.39, 0.83)), whereas no significant differences were found in major or life-threatening bleeding ( RR: 0.98, 95% CI: (0.82, 1.17)) and myocardial infarction ( RR: 1.37, 95% CI: (0.83, 2.26)). Our meta-analysis revealed the safety and efficacy of NOACs may be superior to VKAs in AF patients undergoing TAVI.