Efficacy and outcomes of antiplatelet therapy versus oral anticoagulants in patients undergoing transcatheter aortic valve replacement: a systematic review and meta-analysis

被引：4

作者：

Goyal, Aman ^{[1
,2
]}

Abbasi, Fatima Qayyum ^{[3
]}

Tariq, Muhammad Daoud ^{[4
]}

Kanagala, Sai Gautham ^{[7
]}

Changez, Mah I. Kan ^{[5
]}

Safi, Darsh ^{[1
,2
]}

Basit, Jawad ^{[6
]}

Sulaiman, Samia Aziz ^{[8
]}

Marsool, Mohammed Dheyaa Marsool ^{[9
]}

Daoud, Mohamed ^{[10
,12
]}

Sohail, Amir H. ^{[11
]}

机构：

[1] Seth GS Med Coll, Dept Internal Med, Mumbai, India

[2] King Edward Mem Hosp, Bombay, India

[3] Fed Med Coll, Islamabad, Pakistan

[4] Fdn Univ Med Coll, Islamabad, Pakistan

[5] Quetta Inst Med Sci, Dept Surg, Quetta, Pakistan

[6] Rawalpindi Med Univ, Dept Internal Med, Rawalpindi, Pakistan

[7] Metropolitan Hosp Ctr, Dept Internal Med, New York, NY USA

[8] Univ Jordan, Sch Med, Dept Internal Med, Amman, Jordan

[9] Univ Baghdad, Al Kindy Coll Med, Dept Internal Med, Baghdad, Iraq

[10] Bogomolets Natl Med Univ, Dept Internal Med, Kiev, Ukraine

[11] Univ New Mexico Hlth Sci, Dept Surg, Albuqurque, NM USA

[12] Bogomolets Natl Med Univ, Peremohy Ave 34, UA-02000 Kiev, Ukraine

来源：

ANNALS OF MEDICINE AND SURGERY | 2024年 / 86卷 / 05期

关键词：

antiplatelet therapy; cardiology; direct oral anticoagulants; TAVR; thrombotic complications; vitamin k antagonists; IMPLANTATION; DEFINITIONS;

D O I：

10.1097/MS9.0000000000001908

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background:Recent guidelines suggest that antiplatelet therapy (APT) is the standard of care in the absence of long-term oral anticoagulation (OAC) indications in patients post-transcatheter aortic valve replacement (TAVR). The superiority of one method over the other remains controversial.Materials and methods:Several databases, including MEDLINE, Google Scholar, and EMBASE, were electronically searched. The primary endpoint was the all-cause mortality (ACM) rate. Secondary endpoints included cardiovascular death, myocardial infarction (MI), stroke/TIA, haemorrhagic stroke, bleeding events, systemic embolism, and valve thrombosis in post-TAVR patients receiving APT and oral anticoagulants (OACs). Forest plots were generated using Review Manager version 5.4, with a p value less than 0.05 indicating statistical significance. Subgroup analysis was performed to explore potential sources of heterogeneity.Results:Twelve studies were selected. No significant differences were observed in APT and OAC group for ACM [risk ratio (RR): 0.67; 95% CI:0.45-1.01; P=0.05], cardiovascular death [RR:0.91; 95% CI:0.73-1.14; P=0.42], MI [RR:1.69; 95% CI:0.43-6.72; P=0.46], Stroke/TIA [RR:0.79; 95% CI:0.58-1.06; P=0.12], ischaemic stroke [RR:0.83; 95% CI:0.50-1.37; P=0.47], haemorrhagic stroke [RR:1.08; 95% CI: 0.23-5.15; P=0.92], major bleeding [RR:0.79; 95% CI:0.51-1.21; P=0.28], minor bleeding [RR:1.09; 95% CI: 0.80-1.47; P=0.58], life-threatening bleeding [RR:0.85; 95% CI:0.55-1.30; P=0.45], any bleeding [RR:0.98; 95% CI:0.83-1.15; P=0.78], and systemic embolism [RR:0.87; 95% CI:0.44-1.70; P=0.68]. The risk of valve thrombosis was higher in patients receiving APT than in those receiving OAC [RR:2.61; 95% CI:1.56-4.36; P =0.0002].Conclusions:Although the risk of valve thrombosis increased in patients receiving APT, the risk of other endpoints was comparable between the two groups.

引用

页码：2911 / 2925

页数：15

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