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Antithrombotic strategies after transcatheter aortic valve implantation: Insights from a network meta‐analysis
Author(s) -
Kuno Toshiki,
Takagi Hisato,
Sugiyama Takehiro,
Ando Tomo,
Miyashita Satoshi,
Valentin Nelson,
Shimada Yuichi J.,
Kodaira Masaki,
Numasawa Yohei,
Kanei Yumiko,
Hayashida Kentaro,
Bangalore Sripal
Publication year - 2020
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.28498
Subject(s) - medicine , antithrombotic , hazard ratio , stroke (engine) , meta analysis , randomized controlled trial , cardiology , surgery , confidence interval , mechanical engineering , engineering
Objectives We aimed to investigate the efficacy and safety of different antithrombotic strategies in patients undergoing transcatheter aortic valve implantation (TAVI) using network meta‐analyses. Background Meta‐analyses comparing single antiplatelet therapy (SAPT) vs. dual antiplatelet therapy (DAPT), ± oral anticoagulant (OAC) was conducted to determine the appropriate post TAVI antithrombotic regimen. However, there was limited direct comparisons across the different therapeutic strategies. Methods MEDLINE and EMBASE were searched through December 2018 to investigate the efficacy and safety of different antithrombotic strategies (SAPT, DAPT, OAC, OAC + SAPT, and OAC + DAPT) in patients undergoing TAVI. The main outcome were all‐cause mortality, major or life‐threatening bleeding events, and stroke. Results Our search identified 3 randomized controlled trials and 10 nonrandomized studies, a total of 20,548 patients who underwent TAVI. All OACs were vitamin K antagonists. There was no significant difference on mortality except that OAC + DAPT had significantly higher rates of mortality compared with others ( p < .05, I 2 = 0%). SAPT had significantly lower rates of bleeding compared with DAPT, OAC+SAPT, and OAC+DAPT (hazard ratio [HR]: 0.59 [0.46‐0.77], p < .001, HR: 0.58 [0.34‐0.99], p = .045, HR: 0.41 [0.18‐0.93], p = .033, respectively, I 2 = 0%). There was no significant difference on stroke among all antithrombotic strategies. Conclusion Patients who underwent TAVI had similar all‐cause mortality rates among different antithrombotic strategies except OAC+DAPT. Patients on SAPT had significantly lower bleeding risk than those on DAPT, OAC + SAPT, and OAC + DAPT. Our results suggest SAPT is the preferred regimen when there is no indication for DAPT or OAC. When DAPT or OAC is indicated, DAPT + OAC should be avoided.