Continuation Versus Interruption of Anticoagulation During Transcatheter Aortic Valve Implantation: A Systematic...

Transcatheter aortic valve implantation (TAVI) involves complex decisions regarding perioperative anticoagulation, with continuation or interruption of oral anticoagulation presenting distinct risks and benefits. This systematic review and meta-analysis compared the clinical outcomes of these two strategies during TAVI. We conducted a comprehensive literature search across multiple electronic databases, including PubMed, Embase, Cochrane Library, and Web of Science, from inception to November 2024. Three studies with 2,591 patients (1,132 in the continuation group and 1,459 in the interruption group) met the inclusion criteria. The primary outcomes included all-cause mortality, myocardial infarction (MI), stroke, and major bleeding within one month of the procedure. Risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using a random-effects model. Analysis revealed no significant differences between continuation and interruption groups for all-cause mortality (RR: 0.87, 95% CI: 0.53-1.41, P-value: 0.56), MI (RR: 0.68, 95% CI: 0.23-1.97, P-value: 0.48), stroke (RR: 0.67, 95% CI: 0.42-1.08, P-value: 0.10), or major bleeding (RR: 0.93, 95% CI: 0.69-1.26, P-value: 0.63). No substantial heterogeneity was observed across studies for any outcome. While continued anticoagulation showed a trend toward lower stroke risk, this difference did not reach statistical significance. The findings suggest that both strategies may be reasonable options, though the limited number of studies and short follow-up duration highlights the need for larger randomized controlled trials (RCTs). Until more definitive evidence emerges, the choice between continuation and interruption of oral anticoagulation during TAVI should be individualized based on patient-specific thromboembolic and bleeding risk factors.