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Updated: Jan 1, 2026
Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation
Published on: August 8, 2025
Comparative efficacy and safety of antithrombotic therapy for transcatheter aortic valve replacement: a systematic
Yuexin Zhu1,2, Ziyuan Zou1, Yusi Huang1,2
1First Clinical Medical College, State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Insights
Optimal antithrombotic therapy after transcatheter aortic valve replacement is crucial. Oral anticoagulants (OAC) may reduce stroke and bleeding risks, while dual antiplatelet therapy plus OAC should be avoided due to high bleeding risk.
Area of Science:
- Cardiology
- Interventional Cardiology
- Pharmacology
Background:
- Transcatheter aortic valve replacement (TAVR) is a common procedure for aortic stenosis.
- Optimal antithrombotic strategies post-TAVR are not well-defined.
- Balancing the risks of bleeding and thromboembolic events is critical.
Purpose of the Study:
- To determine the optimal antithrombotic therapy following TAVR.
- To compare the efficacy and safety of different antithrombotic regimens.
- To identify therapies that minimize bleeding and stroke risk while preventing mortality.
Main Methods:
- A systematic search of scientific databases up to December 2018.
- Pairwise and network meta-analyses were conducted.
- Outcomes assessed included 30-day bleeding, stroke, and all-cause mortality.
Main Results:
- Dual antiplatelet therapy (DAPT) showed a higher risk of bleeding compared to single antiplatelet therapy (SAPT).
- DAPT + oral anticoagulant (OAC) significantly increased bleeding risk compared to SAPT, DAPT, SAPT + OAC, and OAC alone.
- OAC demonstrated superiority in reducing bleeding and stroke risk compared to SAPT and DAPT, but not mortality.
Conclusions:
- SAPT may be associated with less bleeding post-TAVR.
- OAC appears to offer a better balance between stroke and bleeding, potentially reducing mortality risk.
- Combination therapy of DAPT + OAC is associated with the highest bleeding risk and should be avoided.
Objectives:
We sought to determine the optimal antithrombotic therapy after transcatheter aortic valve replacement.
Methods:
Related scientific databases were searched until December 2018. We conducted a pairwise and a network meta-analysis within a frequentist framework, measuring 30-day bleeding, stroke and all-cause mortality. The surface under the cumulative ranking (SUCRA) curve was estimated to rank the therapies. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was performed. The protocol was registered with PROSPERO (CRD42018111163).
Results:
Eight studies comprising 2173 patients were analysed. The risk of 30-day bleeding was higher for dual antiplatelet therapy (DAPT) than single antiplatelet therapy (SAPT) [odds ratio (OR) 1.90 (1.10-3.28); P = 0.02], whereas there was no difference in the risk of 30-day stroke [OR 1.27 (0.38-4.20); P = 0.69] and mortality [OR 1.46 (0.67-3.22); P = 0.34] between DAPT and SAPT. In the network meta-analysis, DAPT + oral anticoagulant (OAC) increased the risk of 30-day bleeding compared with SAPT [OR 6.21 (1.74-22.17); P = 0.005], DAPT [OR 3.27 (1.04-10.32); P = 0.043], SAPT + OAC [OR 4.87 (2.51-9.45); P < 0.001] and OAC [OR 14.4 (1.3-154.7); P = 0.028]. Additionally, patients receiving DAPT + OAC had the highest risks for 30-day bleeding (SUCRA 1.0%). OAC seemed to be superior to SAPT and DAPT in terms of 30-day bleeding (SUCRA OAC: 86.3%, SAPT: 72.3%, DAPT: 32.3%) and stroke (SUCRA 54.2%, 47.4%, 40.5%), but not mortality (SUCRA 69.6%, 74.1%, 43.4%).
Conclusions:
There is a trend towards less bleeding with the application of SAPT, but no mortality benefit with the application of DAPT is shown. The comparison of SAPT, DAPT and OAC shows that OAC may improve the balance between stroke and bleeding, which can reduce the risk of mortality. In addition, the application of DAPT + OAC was ranked the worst amongst all treatment modalities and should be avoided due to an increased risk of bleeding.
Clinical Trial Registration Number:
PROSPERO (International Prospective Register of Systematic Reviews, CRD42018111163).
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