Post-TAVR Patients with Atrial Fibrillation: Are NOACs Better Than VKAs?-A Meta-analysis

Overview

Journal Front Cardiovasc Med

Specialty Cardiology & Vascular Diseases

Date 2023 Sep 18

PMID 37719975

Authors

Lu Wang

Wanyue Sang

Yi Jian

Xiaoxue Zhang

Yafan Han

Feifei Wang

Liang Wang

Suxia Yang

Subinuer Wubulikasimu

Li Yang

Huaxin Sun

Yaodong Li

Affiliations

Soon will be listed here.

Abstract

Objective: This study aimed to compare the efficacy of novel oral anticoagulants (NOACs) with traditional anticoagulants vitamin K antagonists (VKAs) in patients with atrial fibrillation (AF) post transcatheter aortic valve replacement (TAVR).

Methods: Studies comparing the usage of NOACs and VKAs in AF patients with oral anticoagulant indication post-TAVR were retrieved from PubMed, EMBASE, Medline, and Cochrane databases from their building-up to Jan. 2023. The literature was screened in line of inclusion and exclusion criteria. Risk ratio (RR) or odds ratio (OR),95% confidence interval (CI) and number needed to treat (NNT) were calculated for four main indexes that composite endpoints composed mainly of any clinically relevant risk events, stroke, major bleeding, and all-cause mortality. Subsequently, a meta-analysis was performed using the RevMan5.3 and Stata 16.0 software.

Results: In the aggregate of thirteen studies, contained 30388 post-TAVR patients with AF, were included in this meta-analysis. Our results indicated that there was no significant difference in stroke between the NOACs group and the VKAs group, and the NOACs group had a numerically but non-significantly higher number of composite endpoint events compared with the other group. Nevertheless, the incidence of major bleeding [11.29% vs. 13.89%, RR 0.82, 95%CI (0.77,0.88), < 0.00001, ² = 69%, NNT = 38] and all-cause mortality [14.18% vs. 17.61%, RR 0.83, 95%CI (0.79,0.88), < 0.00001, ² = 82%, NNT = 29] were significantly lower in the NOACs group than another group.

Conclusion: Taken together, our data indicated that the usage of NOACs reduced the incidence of major bleeding and all-cause mortality compared to VKAs in post-TAVR patients with AF.

Citing Articles

Antithrombotic Therapy Following Structural Heart Disease Interventions: Current Status and Future Directions.

Mitsis A, Kyriakou M, Christodoulou E, Sakellaropoulos S, Avraamides P Rev Cardiovasc Med. 2024; 25(2):60.

PMID: 39077340 PMC: 11263181. DOI: 10.31083/j.rcm2502060.

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