TY - JOUR
T1 - Antithrombotic therapy and cardiovascular outcomes after transcatheter aortic valve implantation in patients without indications for chronic oral anticoagulation
T2 - a systematic review and network meta-analysis of randomized controlled trials
AU - Guedeney, Paul
AU - Roule, Vincent
AU - Mesnier, Jules
AU - Chapelle, Celine
AU - Portal, Jean Jacques
AU - Laporte, Silvy
AU - Ollier, Edouard
AU - Zeitouni, Michel
AU - Kerneis, Mathieu
AU - Procopi, Niki
AU - Barthelemy, Olivier
AU - Sorrentino, Sabato
AU - Mihalovic, Michal
AU - Silvain, Johanne
AU - Vicaut, Eric
AU - Montalescot, Gilles
AU - Collet, Jean Philippe
N1 - Publisher Copyright:
© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.
PY - 2023/4/1
Y1 - 2023/4/1
N2 - Aims As the antithrombotic regimen that may best prevent ischaemic complications along with the lowest bleeding risk offset following transcatheter aortic valve implantation (TAVI) remains unclear, we aimed to compare the safety and efficacy of antithrombotic regimens in patients without having an indication for chronic oral anticoagulation. Methods and results We conducted a PROSPERO-registered (CRD42021247924) systematic review and network meta-analysis of randomized controlled trials evaluating post-TAVI antithrombotic regimens up to April 2022. We estimated the relative risk (RR) and 95% confidence intervals (95% CIs) using a random-effects model in a frequentist pairwise and network metanalytic approach. We included seven studies comprising 4006 patients with a mean weighted follow-up of 12.9 months. Risk of all-cause death was significantly reduced with dual antiplatelet therapy (DAPT) compared with low-dose rivaroxaban + 3-month single antiplatelet therapy (SAPT) (RR 0.60, 95% CI 0.41–0.88), while no significant reduction was observed with SAPT vs. DAPT (RR 1.02, 95% CI 0.67–1.58) and SAPT and DAPT compared with apixaban or edoxaban (RR 0.60, 95% CI 0.32–1.14 and RR 0.59, 95% CI 0.34–1.02, respectively). SAPT was associated with a significant reduction of life-threatening, disabling, or major bleeding compared with DAPT (RR 0.45, 95% CI 0.29–0.70), apixaban or edoxaban alone (RR 0.45, 95% CI 0.25–0.79), and low-dose rivaroxaban + 3-month SAPT (RR 0.30, 95% CI 0.16–0.57). There were no differences between the various regimens with respect to myocardial infarction, stroke, or systemic embolism. Conclusion Following TAVI in patients without an indication for chronic oral anticoagulant, SAPT more than halved the risk of bleeding compared with DAPT and direct oral anticoagulant-based regimens without significant ischaemic offset.
AB - Aims As the antithrombotic regimen that may best prevent ischaemic complications along with the lowest bleeding risk offset following transcatheter aortic valve implantation (TAVI) remains unclear, we aimed to compare the safety and efficacy of antithrombotic regimens in patients without having an indication for chronic oral anticoagulation. Methods and results We conducted a PROSPERO-registered (CRD42021247924) systematic review and network meta-analysis of randomized controlled trials evaluating post-TAVI antithrombotic regimens up to April 2022. We estimated the relative risk (RR) and 95% confidence intervals (95% CIs) using a random-effects model in a frequentist pairwise and network metanalytic approach. We included seven studies comprising 4006 patients with a mean weighted follow-up of 12.9 months. Risk of all-cause death was significantly reduced with dual antiplatelet therapy (DAPT) compared with low-dose rivaroxaban + 3-month single antiplatelet therapy (SAPT) (RR 0.60, 95% CI 0.41–0.88), while no significant reduction was observed with SAPT vs. DAPT (RR 1.02, 95% CI 0.67–1.58) and SAPT and DAPT compared with apixaban or edoxaban (RR 0.60, 95% CI 0.32–1.14 and RR 0.59, 95% CI 0.34–1.02, respectively). SAPT was associated with a significant reduction of life-threatening, disabling, or major bleeding compared with DAPT (RR 0.45, 95% CI 0.29–0.70), apixaban or edoxaban alone (RR 0.45, 95% CI 0.25–0.79), and low-dose rivaroxaban + 3-month SAPT (RR 0.30, 95% CI 0.16–0.57). There were no differences between the various regimens with respect to myocardial infarction, stroke, or systemic embolism. Conclusion Following TAVI in patients without an indication for chronic oral anticoagulant, SAPT more than halved the risk of bleeding compared with DAPT and direct oral anticoagulant-based regimens without significant ischaemic offset.
KW - Apixaban
KW - Dual antiplatelet therapy
KW - Edoxaban
KW - Rivaroxaban
KW - Single antiplatelet therapy
KW - Transcatheter aortic valve implantation
UR - http://www.scopus.com/inward/record.url?scp=85148095701&partnerID=8YFLogxK
U2 - 10.1093/ehjcvp/pvad003
DO - 10.1093/ehjcvp/pvad003
M3 - Article
C2 - 36640149
AN - SCOPUS:85148095701
SN - 2055-6837
VL - 9
SP - 251
EP - 261
JO - European Heart Journal - Cardiovascular Pharmacotherapy
JF - European Heart Journal - Cardiovascular Pharmacotherapy
IS - 3
ER -