Meta-Analysis Assessing Efficacy and Safety of Vitamin K Antagonists Versus Direct Oral Anticoagulants for Atrial Fibrillation After Transcatheter Aortic Valve Implantation.

Abstract

Patients who underwent transcatheter aortic valve implantation (TAVI) with concomitant atrial fibrillation (AF) are at a higher risk for thromboembolic and bleeding events. The optimal antithrombotic strategy for patients with AF after TAVI remains unclear. We sought to determine the comparative efficacy and safety of direct oral anticoagulants (DOAC) versus oral vitamin K antagonists (VKAs) in these patients. Electronic databases such as PubMed, Cochrane, and Embase databases were searched till January 31, 2023, for relevant studies evaluating clinical outcomes of VKA versus DOAC in patients with AF after TAVI. Outcomes assessed were (1) all-cause mortality, (2) stroke, (3) major/life-threatening bleeding, and (4) any bleeding. Hazard ratios (HRs) were pooled in meta-analysis using random effect model. Nine studies (2 randomized and 7 observational) were included in systematic review, and 8 studies with 25,769 patients were eligible to be included in the meta-analysis. The mean age of the patients was 82.1 years, and 48.3% were male. Pooled analysis using random-effects model showed no statistically significant difference in all-cause mortality (HR 0.91, 95% confidence interval [CI] 0.76 to 1.10, p = 0.33), stroke (HR 0.96, 95% CI 0.80 to 1.16, p = 0.70), and major/life-threatening bleeding (HR 1.05, 95% CI 0.82 to 1.35, p = 0.70) in patients that received DOAC compared with oral VKA. Risk of any bleeding was lower in the DOAC group compared with oral VKA (HR 0.83, 95% CI 0.76 to 0.91, p = 0.0001). In patients with AF, DOACs appear to be a safe alternative oral anticoagulation strategy to oral VKA after TAVI. Further randomized studies are required to confirm the role of DOACs in those patients.

• Authors: Vijairam Selvaraj, Mohammad Saud Khan, Syed Hamzah Mufarrih, Mohammed Kazimuddin, Mohammad Abdul Waheed, Avnish Tripathi, Chirag Bavishi, Omar N Hyder, Herbert D Aronow, Marwan Saad, J Dawn Abbott
• Journal: The American journal of cardiology (Am J Cardiol) Vol. 201 Pg. 260-267 (08 15 2023) ISSN: 1879-1913 [Electronic] United States
• PMID: 37393728 (Publication Type: Meta-Analysis, Journal Article)
• Copyright: Copyright © 2023 Elsevier Inc. All rights reserved.

Chemical References

• Fibrinolytic Agents
• Anticoagulants
• Vitamin K

Topics

• Humans
• Male
• Aged, 80 and over
• Female
• Atrial Fibrillation (complications, drug therapy, surgery)
• Transcatheter Aortic Valve Replacement (adverse effects)
• Fibrinolytic Agents (therapeutic use)
• Anticoagulants (therapeutic use)
• Stroke (epidemiology, etiology, prevention & control)
• Hemorrhage (chemically induced, epidemiology, complications)
• Vitamin K
• Administration, Oral
• Randomized Controlled Trials as Topic