Why the study?
Diverse antithrombotic strategies are used after aortic valve replacement, but the optimal therapeutic regimen following TAVI/TAVR remains unclear.
Do different antithrombotic strategies (DOACs, aspirin, or DAPT) improve mortality and reduce bleeding compared to warfarin or aspirin monotherapy in patients after TAVI/TAVR?
Comparison
Various antithrombotic regimens including DOACs, warfarin, aspirin, and DAPT
Design
Systematic review and meta-analysis of 3 RCTs and 10 non-randomized studies
Follow-up
≥3 months
Key result
Aspirin showed a favorable risk-benefit profile versus warfarin after TAVI/TAVR, with lower rates of all-cause mortality (RR 0.71; 95% CI 0.54-0.93; P=0.012) and bleeding events.
Authors
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Optimal antithrombotic regimen after TAVI remains unclear; RCT evidence leaves practice guidance open.
Meta-Analysis (n=23,497)
Do different antithrombotic strategies (DOACs, aspirin, or DAPT) improve mortality and reduce bleeding compared to warfarin or aspirin monotherapy in patients after TAVI/TAVR?
Relative Risk: 0.71 (95% CI 0.54–0.93)
p-value: p=0.012
Following TAVI/TAVR, aspirin monotherapy offers a favorable risk-benefit profile compared to warfarin, while DAPT reduces mortality but significantly increases bleeding risk compared to aspirin.
Yang et al. (2021) conducted a meta-analysis in Transcatheter aortic valve implantation/replacement (TAVI/TAVR) (n=23,497). Antithrombotic therapies (Aspirin, DAPT, DOACs) vs. Warfarin or Aspirin monotherapy was evaluated on All-cause mortality (Aspirin vs Warfarin) (RR 0.71, 95% CI 0.54-0.93, p=0.012). Aspirin showed a favorable risk-benefit profile versus warfarin after TAVI/TAVR, with lower rates of all-cause mortality (RR 0.71; 95% CI 0.54-0.93; P=0.012) and bleeding events.