Related Experiment Video
Updated: Jun 16, 2026
Fully Endoscopic Mitral Valve Repair with Percutaneous Cannulation of Groin Vessels
Published on: May 26, 2023
Antithrombotic therapy in patients after transcatheter aortic valve implantation: a network meta-analysis
Ricky D Turgeon1,2, Ursula M Ellis3, Arden R Barry1,4
1Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, V6T 1Z3, Canada.
Aims:
The optimal antithrombotic therapy to balance the risk of thrombosis and bleeding in patients who undergo transcatheter aortic valve implantation (TAVI) is unknown. This systematic review/network meta-analysis of randomized controlled trials (RCTs) aimed to evaluate the efficacy and safety of different oral anticoagulant (OAC) and antiplatelet regimens in patients post-TAVI.
Methods And Results:
MEDLINE, Embase, CENTRAL, and ClinicalTrials.gov were searched from inception to April 2023. Co-primary outcomes were all-cause death and major bleeding. We conducted Bayesian network meta-analyses to compare all interventions simultaneously. For each outcome, we generated odds ratios (ORs) with 95% credible intervals using a random-effects model with informative priors, and ranked interventions based on mean surface under the cumulative ranking curve. We included 11 RCTs (n = 6415), including 1 unpublished RCT. Three trials enrolled patients with an indication for an OAC. Overall risk of bias was low or with some concerns. Median age was 81 years. Median follow-up was 6 months. The combination of OAC plus single antiplatelet therapy (SAPT) increased the risk of all-cause death compared with dual antiplatelet therapy (DAPT) (OR 1.78, 95% credible interval 1.15-2.77). No other comparisons for all-cause death were significantly different. For major bleeding, SAPT reduced the risk compared with DAPT, direct-acting OAC, and OAC + SAPT (OR 0.20-0.40), and DAPT reduced the risk compared with OAC + SAPT. SAPT and DAPT ranked best for all-cause death, while SAPT ranked best for major bleeding.
Conclusion:
In post-TAVI patients, SAPT may provide the optimal balance of reducing thrombotic events while minimizing the risk of bleeding.
Insights
For patients after transcatheter aortic valve implantation (TAVI), single antiplatelet therapy (SAPT) appears to offer the best balance. It may reduce thrombotic events and bleeding risks compared to other antithrombotic strategies.
Area of Science:
- Cardiology
- Interventional Cardiology
- Pharmacology
Background:
- Optimal antithrombotic therapy post-transcatheter aortic valve implantation (TAVI) remains undefined.
- Balancing thrombosis and bleeding risks is critical for TAVI patients.
Purpose of the Study:
- To evaluate the efficacy and safety of various oral anticoagulant (OAC) and antiplatelet regimens in patients following TAVI.
- To compare different antithrombotic strategies using a network meta-analysis of randomized controlled trials (RCTs).
Main Methods:
- Systematic review and Bayesian network meta-analysis of 11 RCTs (n=6415) up to April 2023.
- Co-primary outcomes: all-cause death and major bleeding.
- Interventions ranked by surface under the cumulative ranking curve.
Main Results:
- Single antiplatelet therapy (SAPT) and dual antiplatelet therapy (DAPT) showed comparable outcomes for all-cause death.
- SAPT significantly reduced major bleeding risk compared to DAPT, direct-acting OAC, and OAC + SAPT.
- OAC + SAPT increased the risk of all-cause death compared to DAPT.
Conclusions:
- Single antiplatelet therapy (SAPT) may be the optimal antithrombotic strategy for post-TAVI patients.
- SAPT offers a favorable balance between reducing thrombotic events and minimizing bleeding risk.
More Related Videos
06:59Improved Registration of 3D CT Angiography with X-ray Fluoroscopy for Image Fusion During Transcatheter Aortic Valve Implantation
Published on: June 3, 2018
08:50Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement
Published on: March 26, 2018
