Valvular & structural heart disease
Antithrombotic therapy and cardiovascular outcomes after transcatheter aortic valve implantation in patients without indications for chronic oral anticoagulation: a systematic review and network meta-analysis of randomized controlled trials
Authors' 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.
Study context
- Population
- Patients after transcatheter aortic valve implantation (TAVI) without an indication for chronic OAC; RCTs up to April 2022
- Participants
- 4,006 patients7 RCTs
- Comparison
- Post-TAVI antithrombotic regimens: Single antiplatelet therapy (SAPT) vs dual antiplatelet therapy (DAPT) vs low-dose rivaroxaban + 3-month SAPT vs apixaban or edoxaban
- Outcome
- All-cause death
- Follow-up
- Mean weighted 12.9 months
Methodological detailsrandom-effects model, frequentist pairwise and network meta-analysis
- Random-effects model
- Frequentist pairwise and network meta-analysis
Pooled result
As reported in the abstract
Relative risk (95% CI)
DAPTvs Low-dose rivaroxaban + 3-month SAPT
0.60(0.41–0.88)
SAPTvs DAPT
1.02(0.67–1.58)
SAPTvs Apixaban or edoxaban
0.60(0.32–1.14)
DAPTvs Apixaban or edoxaban
0.59(0.34–1.02)
Further pooled results
MI, stroke or systemic embolism
- No differences between the various regimens
Safety
| Outcome | RR (95% CI) | |
|---|---|---|
| Life-threatening, disabling or major bleedingSAPTvs DAPT | 0.45 (0.29–0.70) | |
| Life-threatening, disabling or major bleedingSAPTvs Apixaban or edoxaban | 0.45 (0.25–0.79) | |
| Life-threatening, disabling or major bleedingSAPTvs Low-dose rivaroxaban + 3-month SAPT | 0.30 (0.16–0.57) | |
| 0.10.31310Relative risk (log scale) |
Original publication
Antithrombotic therapy and cardiovascular outcomes after transcatheter aortic valve implantation in patients without indications for chronic oral anticoagulation: a systematic review and network meta-analysis of randomized controlled trials. Eur Heart J Cardiovasc Pharmacother. Published 14 January 2023. doi:10.
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