Novel oral anticoagulants versus vitamin K antagonists in patients with atrial fibrillation after transcatheter aortic valve replacement: A systematic review and meta-analysis.
Abstract
<h4>Background</h4>The efficacy and safety of novel oral anticoagulants (NOACs) compared
to the current guideline-recommended vitamin K antagonists (VKAs) in atrial fibrillation
(AF) patients undergoing transcatheter aortic valve replacement (TAVR) has not been
well established. We pooled evidence from all available studies to assess the risks
and benefits of this drug class.<h4>Methods</h4>We queried electronic databases (MEDLINE,
Scopus, and Cochrane central) up until January 28th, 2022 for studies comparing NOACs
to VKAs in AF patients undergoing TAVR. Results from studies were presented as risk
ratios (RR) and pooled using a random-effects model. Subgroup analysis by study design
and meta-regression analysis were performed to explore heterogeneity.<h4>Results</h4>A
total of 12 studies (3 RCTs and 9 observational) containing 12,203 patients (mean
age 81.2 years; 50.5% men) were identified and included in the analysis. Pooled analysis
revealed no significant difference between NOACs and VKAs in terms of stroke or systemic
embolism (RR: 0.78; p = 0.18), major bleeding (RR: 0.84; p = 0.32), intracranial hemorrhage
(RR 0.61; p = 0.06), all-cause mortality (RR: 0.69; p = 0.07), and myocardial infarction
(RR: 1.60; p = 0.24) at a mean length of follow-up of 15.1 months. RCTs and observational
studies did not significantly differ across outcomes on subgroup analysis. Meta-regression
analysis found heterogeneity in all-cause mortality to be significantly explained
by percentage of males (coefficient: 0.049, p = 0.007), mean age (coefficient: 0.221,
p < 0.001), and CHA2DS2-VASc score (coefficient: -1.657, p < 0.001).<h4>Conclusions</h4>This
meta-analysis suggests that outcomes with NOACs do not significantly differ compared
to VKAs following TAVR in patients with AF.
Type
Journal articleSubject
Warfarinatrial fibrillation
novel oral anticoagulants
transcatheter aortic valve replacement
vitamin K antagonists
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https://hdl.handle.net/10161/24976Published Version (Please cite this version)
10.1002/ccd.30213Publication Info
Memon, Muhammad Mustafa; Siddiqui, Asad Ali; Amin, Emaan; Shaikh, Fahd Niaz; Khan,
Muhammad Shahzeb; Doukky, Rami; & Krasuski, Richard A (2022). Novel oral anticoagulants versus vitamin K antagonists in patients with atrial fibrillation
after transcatheter aortic valve replacement: A systematic review and meta-analysis.
Catheterization and cardiovascular interventions : official journal of the Society
for Cardiac Angiography & Interventions. 10.1002/ccd.30213. Retrieved from https://hdl.handle.net/10161/24976.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Richard Andrew Krasuski
Professor of Medicine

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