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

Area of Science:

• Cardiology
• Interventional Cardiology
• Pharmacology

Background:

• Optimal antithrombotic therapy following transcatheter aortic valve replacement (TAVR) is not well-established.
• Existing evidence lacks consensus on the best antithrombotic regimen to balance efficacy and safety.

Purpose of the Study:

• To conduct a network meta-analysis of randomized controlled trials (RCTs).
• To compare outcomes of various antithrombotic strategies after TAVR.
• To determine the optimal antithrombotic therapy in patients without other anticoagulation indications.

Main Methods:

• Systematic literature search of PubMed/Medline and Cochrane databases up to January 6, 2022.
• Network meta-analysis using a random-effects model.
• Inclusion of six RCTs assessing stroke, bleeding, myocardial infarction, and mortality.

Main Results:

• Single antiplatelet therapy (SAPT) significantly reduced major or life-threatening bleeding compared to dual antiplatelet therapy (DAPT) [OR: 0.42; 95% CI: 0.25-0.70].
• No significant differences were observed in stroke, myocardial infarction, or mortality rates among antithrombotic strategies.
• Other strategies showed similar bleeding risks compared to DAPT.

Conclusions:

• SAPT is the preferred antithrombotic regimen post-TAVR for patients without other anticoagulation indications.
• Further research from trials like ADAPT-TAVR, CLOE, and ATLANTIS will refine understanding of post-TAVR antithrombotic management.