Post-Transcatheter Aortic Valve Replacement Antithrombotic Treatment in Nonindicated Patients
Year: 2025
Type: article
Study designs: Systematic Review, Meta-Analysis
Abstract: BACKGROUND: The optimal antithrombotic strategy following transcatheter aortic valve replacement (TAVR) remains controversial. OBJECTIVES: The authors aimed to determine the safety and efficacy of various antithrombotic regimens in patients without an indication for anticoagulation following TAVR. METHODS: We conducted a systematic search in PubMed, Embase, Scopus, and ClinicalTrials.gov until August 2024 for studies investigating antithrombotic regimens after TAVR in patients without an indication for chronic oral anticoagulation. The analysis compared single antiplatelet therapy (SAPT), dual antiplatelet therapy (DAPT), direct oral anticoagulants, and oral anticoagulant (OAC) plus SAPT. A frequentist network meta-analysis was employed to evaluate the post-TAVR risk of all-cause mortality, cardiovascular mortality, myocardial infarction, stroke, total bleeding, and life-threatening or major bleeding. RESULTS: Eleven studies (8 randomized controlled trials and 3 propensity score-matched cohorts) comprising 5,821 patients undergoing TAVR were included. SAPT significantly reduced the risk of life-threatening/major bleeding compared with DAPT (OR: 0.53; 95% CI: 0.35-0.80), OAC (OR: 0.52; 95% CI: 0.28-0.99), and OAC + SAPT (OR: 0.32; 95% CI: 0.13-0.76). No significant differences were observed in the risk of cardiovascular mortality, stroke, or myocardial infarction between antithrombotic regimens. Subgroup analysis indicated an increased risk of mortality with low-dose rivaroxaban+3-month SAPT compared with SAPT (OR: 0.56; 95% CI: 0.35-0.89) and DAPT (OR: 0.58; 95% CI: 0.38-0.88). Meta-regression identified chronic obstructive pulmonary disease as the only significant modifier of bleeding risk following TAVR. CONCLUSIONS: 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.
Source: JACC Advances
Authors: Sahand Siami, Sina Kazemian, Saba Maleki, Elham Ebrahimi, Fatemeh Jodeiri, Mandana Ebrahimzade, Mohsen Hajiqasemi, Sara Ebrahimi, Maede Mehdizadeh, Mona Aghaei, Mohammad-Mahdi Bastan, Mehrshad Fathian Sabet, Roozbeh Nazari, Pouya Ebrahimi, Jamal S. Rana, Michael G. Nanna, Jay Giri, Dhaval Kolte, Tor Biering-Sørensen, Mohamad Alkhouli, Kaveh Hosseini
Institutions: Islamic Azad University, Tehran, Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Shahid Beheshti University, Shahid Beheshti University of Medical Sciences, The University of Texas MD Anderson Cancer Center, Islamic Azad University Medical Branch of Tehran, McLaren Regional Medical Center, Michigan State University, Kaiser Permanente, Kaiser Permanente Northern California, Yale University, University of Pennsylvania, Harvard University, Massachusetts General Hospital, Gentofte Hospital, Mayo Clinic
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,936
OpenAlex ID: W4409051471