Related Experiment Video
Updated: May 17, 2025
Photoselective Vaporesection of the Prostate via an End-firing Lithium Triborate Crystal Laser
Published on: May 9, 2018
Outcomes of periprocedural continuation vs interruption of oral anticoagulation in transcatheter aortic valve
Aman Goyal1, Aqsa Shoaib2, Areeba Fareed2
1Department of Internal Medicine, Seth GS Medical College and KEM Hospital, Mumbai 400012, Maharashtra, India.
Insights
Continuing oral anticoagulation (OAC) during transcatheter aortic valve replacement (TAVR) significantly reduces stroke risk. While trends suggest lower bleeding and mortality, further research is needed for definitive conclusions.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- Many patients undergoing transcatheter aortic valve replacement (TAVR) require oral anticoagulation (OAC), often due to atrial fibrillation.
- The optimal management of OAC around the time of TAVR is not well-established.
Purpose of the Study:
- To compare the safety and efficacy of continuing versus interrupting oral anticoagulation (OAC) during transcatheter aortic valve replacement (TAVR).
Main Methods:
- A meta-analysis of four studies involving 1813 patients undergoing TAVR.
- Compared outcomes between patients who continued OAC and those who interrupted it.
- Utilized a random-effects model to calculate risk ratios (RR) and 95% confidence intervals (CI).
Main Results:
- Continuation of OAC was associated with a significantly lower incidence of stroke (RR = 0.62; P = 0.03).
- No significant differences were observed in major vascular complications (RR = 0.95; P = 0.60) or major bleeding (RR = 0.90; P = 0.33).
- All-cause mortality showed no significant difference between groups (RR = 0.83; P = 0.32).
Conclusions:
- Continuing OAC during TAVR significantly reduces stroke risk.
- Trends suggest potential benefits in reduced bleeding and mortality, though not statistically significant.
- Larger studies are warranted to confirm the clinical significance of these findings.
Background:
Up to one-third of patients undergoing transcatheter aortic valve replacement (TAVR) have an indication for oral anticoagulation (OAC), primarily due to underlying atrial fibrillation. The optimal approach concerning periprocedural continuation vs interruption of OAC in patients undergoing TAVR remains uncertain, which our meta-analysis aims to address.
Aim:
To explore safety and efficacy outcomes for patients undergoing TAVR, comparing periprocedural continuation vs interruption of OAC therapy.
Methods:
A literature search was conducted across major databases to retrieve eligible studies that assessed the safety and effectiveness of TAVR with periprocedural continuous vs interrupted OAC. Data were pooled using a random-effects model with risk ratio (RR) and their 95% confidence interval (CI) as effect measures. All statistical analyses were conducted using Review Manager with statistical significance set at P < 0.05.
Results:
Four studies were included, encompassing a total of 1813 patients with a mean age of 80.6 years and 49.8% males. A total of 733 patients underwent OAC interruption and 1080 continued. Stroke incidence was significantly lower in the OAC continuation group (RR = 0.62, 95%CI: 0.40-0.94; P = 0.03). No significant differences in major vascular complications were found between the two groups (RR = 0.95, 95%CI: 0.77-1.16; P = 0.60) and major bleeding (RR = 0.90, 95%CI: 0.72-1.12; P = 0.33). All-cause mortality was non-significant between the two groups (RR = 0.83, 95%CI: 0.57-1.20; P = 0.32).
Conclusion:
Continuation of OAC significantly reduced stroke risk, whereas it showed trends toward lower bleeding and mortality that were not statistically significant. Further large-scale studies are crucial to determine clinical significance.
Related Concept Videos
01:26Endoscopic Procedures IV: Sigmoidoscopy and Laproscopy
Sigmoidoscopy
Sigmoidoscopy is a diagnostic procedure that uses a flexible sigmoidoscope equipped with a light source and camera to examine the rectum and sigmoid colon. The procedure involves inserting the tube through the anus...
01:26Endoscopic Studies II: Thoracocentesis
Description
Excess pleural fluid or air may accumulate in some respiratory disorders in the thoracic cavity. To treat pleural effusion, a physician conducts thoracentesis by carefully piercing the chest wall and entering...
01:29Suctioning the Nasopharyngeal Airway
Equipment Required
01:25Endoscopic Procedures II: Colonoscopy
01:26Endoscopic Procedures V: ERCP
Patient...
01:30Endoscopic Studies I: Bronchoscopy and Thoracoscopy
Bronchoscopy
Description
Bronchoscopy is a procedure that involves direct visualization of the larynx, trachea, and bronchi for diagnostic and therapeutic purposes. A flexible fiber optic or rigid bronchoscope is used to carry out the procedure. The fiber-optic bronchoscope is more frequently used due...