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Meta-analysis Comparing Direct Oral Anticoagulants Versus Vitamin K Antagonists After Transcatheter Aortic Valve

Hiroki Ueyama1, Toshiki Kuno1, Tomo Ando2

  • 1Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, New York.

The American Journal of Cardiology
|January 23, 2020
PubMed

Insights

For patients undergoing transcatheter aortic valve implantation (TAVI) with a need for oral anticoagulation, direct oral anticoagulants (DOACs) show similar safety and efficacy to vitamin K antagonists (VKAs). This meta-analysis found no significant differences in mortality, bleeding, or stroke between DOACs and VKAs in this patient group.

Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Trials

Background:

  • Atrial fibrillation (AF) is a frequent comorbidity in patients undergoing transcatheter aortic valve implantation (TAVI).
  • The comparative safety and efficacy of direct oral anticoagulants (DOACs) versus vitamin K antagonists (VKAs) in TAVI patients requiring oral anticoagulation is not well-established.

Purpose of the Study:

  • To compare the safety and efficacy of DOACs against VKAs in patients undergoing TAVI who have an indication for oral anticoagulation.
  • To evaluate key outcomes including mortality, stroke, and major bleeding events.

Main Methods:

  • A systematic literature search was conducted on PubMed and EMBASE up to October 2019.
  • Meta-analysis of 5 eligible studies involving 2,569 patients who underwent TAVI and required oral anticoagulation.

Main Results:

  • No significant differences were observed in all-cause mortality (OR 1.07, 95% CI [0.73-1.57]) between DOACs and VKAs.
  • Major and/or life-threatening bleeding events were similar between the two anticoagulant groups (OR 0.85, 95% CI [0.64-1.12]).
  • Stroke incidence did not differ significantly between patients treated with DOACs and VKAs (OR 1.52, 95% CI [0.93-2.48]).

Conclusions:

  • In TAVI patients requiring oral anticoagulation, DOACs and VKAs demonstrate comparable safety and efficacy profiles.
  • Further large-scale randomized controlled trials are warranted to determine the optimal oral anticoagulation strategy for this population.

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