Oral anticoagulation and antiplatelet therapy after transcatheter aortic valve replacement: A systematic review and Meta-analysis / 中华老年医学杂志

ABSTRACT

Objective:To assess the efficacy and safety of different antithrombotic strategies in patients following transcatheter aortic valve replacement(TAVR).Methods:A computerized search was performed to identify all relevant publications from PubMed, EMbase, CNKI and Wangfang databases.Non-randomized controlled trials of oral anticoagulant(OAC) vs. antiplatelet therapy(APT)and vitamin K antagonists(VKAs) vs. non-vitamin K antagonist oral anticoagulants(NOACs)after TAVR were collected, and the effects on postoperative bleeding, cerebrovascular events and all-cause mortality were analyzed.A meta-analysis was performed using RevMan 5.2 software provided by the Cochrane Collaboration. Results:A total of 9 studies were included.Compared with APT, the incidence of bleeding events caused by OAC increased(20.3% vs. 26.3%, OR=1.20, 95% CI 1.04-1.39, P=0.01), while the incidence of cardiovascular events and all-cause mortality had no statistical difference.In the OAC group, all-cause mortality was lower in the VKAs group than in the NOACs group(9.8% vs. OR=0.73, 95% CI 0.55-0.97, P=0.03). However, there was no statistical significance in cardiovascular and bleeding events( P>0.05). Conclusions:Compared with patients receiving APT, the incidence of bleeding events is higher in patients taking OAC.In patients taking OAC, VKAs can significantly decrease the mortality compared with NOACs.