Toshiki Kuno1, Hisato Takagi2, Takehiro Sugiyama3,4,5, Tomo Ando6, Satoshi Miyashita1, Nelson Valentin1, Yuichi J Shimada7, Masaki Kodaira8, Yohei Numasawa8, Yumiko Kanei9, Kentaro Hayashida10, Sripal Bangalore11. 1. Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, New York. 2. Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan. 3. Diabetes and Metabolism Information Center, Research Institute, Center for Global Health and Medicine, Tokyo, Japan. 4. Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan. 5. Department of Public Health/Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. 6. Department of Cardiology, Detroit Medical Center, Detroit, Michigan. 7. Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York. 8. Department of Cardiology, Japanese Red Cross Ashikaga Hospital, Ashikaga, Japan. 9. Department of Cardiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, New York. 10. Department of Cardiology, Keio University School of Medicine, Tokyo, Japan. 11. New York University School of Medicine, New York, New York.
Abstract
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, I2 = 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, I2 = 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.
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, I2 = 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, I2 = 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.
Authors: Costanza Pellegrini; Erion Xhepa; Gjin Ndrepepa; Hector Alvarez-Covarrubias; Sebastian Kufner; Anna Lena Lahmann; Tobias Rheude; Himanshu Rai; N Patrick Mayr; Heribert Schunkert; Adnan Kastrati; Michael Joner; Salvatore Cassese Journal: Clin Res Cardiol Date: 2020-12-23 Impact factor: 5.460