Key result
Antiplatelet therapy matches anticoagulants for post-TAVR mortality but increases valve thrombosis risk.
Why the study?
The superiority of antiplatelet therapy versus oral anticoagulants in patients post-transcatheter aortic valve replacement remains controversial.
Does antiplatelet therapy reduce all-cause mortality compared to oral anticoagulants in patients post-transcatheter aortic valve replacement?
Meta-Analysis (n=7,418)
Does antiplatelet therapy reduce all-cause mortality compared to oral anticoagulants in patients post-transcatheter aortic valve replacement?
Relative Risk: 0.67 (95% CI 0.45–1.01)
Absolute Event Rate: 8.35% vs 10.4%
p-value: p=0.05
In post-TAVR patients, antiplatelet therapy results in similar rates of mortality and major bleeding compared to oral anticoagulants, but is associated with a significantly higher risk of valve thrombosis.
May favor oral anticoagulants to mitigate valve thrombosis post-TAVR; leaves open mortality impact and need for randomized trials before practice change.
Background: Recent guidelines suggest that antiplatelet therapy (APT) is the standard of care in the absence of long-term oral anticoagulation (OAC) indications in patients post-transcatheter aortic valve replacement (TAVR). The superiority of one method over the other remains controversial. Materials and methods: Several databases, including MEDLINE, Google Scholar, and EMBASE, were electronically searched. The primary endpoint was the all-cause mortality (ACM) rate. Secondary endpoints included cardiovascular death, myocardial infarction (MI), stroke/TIA, haemorrhagic stroke, bleeding events, systemic embolism, and valve thrombosis in post-TAVR patients receiving APT and oral anticoagulants (OACs). Forest plots were generated using Review Manager version 5.4, with a p value less than 0.05 indicating statistical significance. Subgroup analysis was performed to explore potential sources of heterogeneity. Results: Twelve studies were selected. No significant differences were observed in APT and OAC group for ACM [risk ratio (RR): 0.67; 95% CI:0.45–1.01; P =0.05], cardiovascular death [RR:0.91; 95% CI:0.73–1.14; P =0.42], MI [RR:1.69; 95% CI:0.43–6.72; P =0.46], Stroke/TIA [RR:0.79; 95% CI:0.58–1.06; P =0.12], ischaemic stroke [RR:0.83; 95% CI:0.50–1.37; P =0.47], haemorrhagic stroke [RR:1.08; 95% CI: 0.23–5.15; P =0.92], major bleeding [RR:0.79; 95% CI:0.51–1.21; P =0.28], minor bleeding [RR:1.09; 95% CI: 0.80–1.47; P =0.58], life-threatening bleeding [RR:0.85; 95% CI:0.55–1.30; P =0.45], any bleeding [RR:0.98; 95% CI:0.83–1.15; P =0.78], and systemic embolism [RR:0.87; 95% CI:0.44–1.70; P =0.68]. The risk of valve thrombosis was higher in patients receiving APT than in those receiving OAC [RR:2.61; 95% CI:1.56–4.36; P =0.0002]. Conclusions: Although the risk of valve thrombosis increased in patients receiving APT, the risk of other endpoints was comparable between the two groups.
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Goyal et al. (2024) conducted a meta-analysis in Transcatheter aortic valve replacement (TAVR) (n=7,418). Antiplatelet therapy vs. Oral anticoagulants was evaluated on All-cause mortality (RR 0.67, 95% CI 0.45-1.01, p=0.05). Antiplatelet therapy compared to oral anticoagulants post-TAVR showed no significant difference in all-cause mortality, but was associated with a significantly higher risk of valve thrombosis.
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