Valvular & structural heart disease
Post-Transcatheter Aortic Valve Replacement Antithrombotic Treatment in Nonindicated Patients: Updated Systematic Review and Network Meta-Analysis
Authors' conclusion
Our findings support current guidelines recommending SAPT as the preferred antithrombotic strategy post-TAVR in patients without an indication for anticoagulation, demonstrating optimal safety without compromising efficacy.
Study context
- Population
- Patients undergoing transcatheter aortic valve replacement (TAVR) without an indication for chronic oral anticoagulationpatients undergoing TAVR in 11 studies · randomized controlled trials 8 · propensity score-matched cohorts 3
- Participants
- 5,821 patients
- Comparison
- The analysis compared single antiplatelet therapy (SAPT), dual antiplatelet therapy (DAPT), direct oral anticoagulants, and oral anticoagulant (OAC) plus SAPT.
- Outcome
- Cardiovascular mortality, stroke, myocardial infarction
Methodological detailssystematic search in PubMed, Embase, Scopus, and ClinicalTrials.gov until August 2024, 8 randomized controlled trials and 3 propensity score-matched cohorts
- Systematic search in PubMed, Embase, Scopus, and ClinicalTrials.gov until August 2024
- 8 randomized controlled trials and 3 propensity score-matched cohorts
Pooled result
As reported in the abstract
- No significant differences between antithrombotic regimens
Further pooled results
| Outcome | OR (95% CI) |
|---|---|
| Mortality (subgroup analysis)Low-dose rivaroxaban+3-month SAPT vs SAPT · subgroup analysis | 0.56 (0.35–0.89) |
| Mortality (subgroup analysis)Low-dose rivaroxaban+3-month SAPT vs DAPT · subgroup analysis | 0.58 (0.38–0.88) |
- Mortality (subgroup analysis): reported as increased risk of mortality with low-dose rivaroxaban+3-month SAPT; OR as printed
- Mortality (subgroup analysis): reported as increased risk of mortality with low-dose rivaroxaban+3-month SAPT; OR as printed
Modifiers of bleeding risk (meta-regression)
- Chronic obstructive pulmonary disease the only significant modifier of bleeding risk
Safety
| Outcome | OR (95% CI) | |
|---|---|---|
| Life-threatening/major bleedingSAPTvs DAPT | 0.53 (0.35–0.80) | |
| Life-threatening/major bleedingSAPTvs OAC | 0.52 (0.28–0.99) | |
| Life-threatening/major bleedingSAPTvs OAC + SAPT | 0.32 (0.13–0.76) | |
| 0.10.31310Odds ratio (log scale) |
Original publication
Post-Transcatheter Aortic Valve Replacement Antithrombotic Treatment in Nonindicated Patients: Updated Systematic Review and Network Meta-Analysis. JACC Adv. Published 31 March 2025. doi:10.
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