Antithrombotic Strategy After Transcatheter Aortic Valve Replacement: A Network Meta-Analysis

The ideal antithrombotic therapy post transcatheter aortic valve replacement (TAVR) remains uncertain. We performed a network metaanalysis of RCTs to report the outcomes with various antithrombotic strategies to determine the optimal therapy. A systematic search of the PubMed/Medline and Cochrane databases was performed through January 6, 2022. The primary outcome was stroke and the secondary outcomes were major/life-threatening bleeding, myocardial infarction, all-cause mortality, and cardiac mortality. A network meta-analysis was conducted with a random-effects model. All analysis was carried out using R version 4.0.3. Six RCTs were included in the final analysis. SAPT when compared with DAPT was associated with a reduced risk of major or life-threatening bleeding [OR: 0.42; 95% CI: 0.25-0.70]. Other antithrombotic strategies were associated with similar odds of major and life-threatening bleeding post TAVR compared with DAPT. There was no difference in the incidence of stroke, myocardial infarction, all-cause and cardiac mortality between the various antithrombotic strategies post TAVR. The present analysis reported SAPT as the preferred antithrombotic regimen post TAVR compared with other regimens in patients who do not have other indications for anticoagulation. Additional studies such as ADAPT-TAVR, CLOE and ATLANTIS trials will further add to our understanding of the adequate antithrombotic regimen post TAVR in patients with otherwise no indication for anticoagulation.

Automated summary

The optimal antithrombotic therapy post transcatheter aortic valve replacement (TAVR) remains uncertain. A network meta-analysis of randomized controlled trials was conducted to determine the outcomes with various antithrombotic strategies. The results showed that single antiplatelet therapy (SAPT) was associated with a reduced risk of major or life-threatening bleeding compared to dual antiplatelet therapy (DAPT). Other antithrombotic strategies had similar odds of major and life-threatening bleeding compared to DAPT. There were no differences in the incidence of stroke, myocardial infarction, all-cause mortality, and cardiac mortality among the various antithrombotic strategies post TAVR.