Perioperative continuous vs. interrupted oral anticoagulation in TAVR: a systematic review and meta-analysis

To evaluate the clinical outcomes associated with continuous versus interrupted oral anticoagulation strategies during the perioperative period of transcatheter aortic valve replacement, with a focus on balancing thromboembolic and bleeding risks.

We searched PubMed, Web of Science, Cochrane Library, Scopus, Ovid and Embase up to February 2026. All studies compared continuous oral anticoagulation versus interruption of oral anticoagulation for TAVI. The primary outcomes were major bleeding, major vascular complications, and stroke. Data synthesis was performed by calculating risk ratios (RRs) or standardized mean differences (SMDs), each accompanied by 95% confidence intervals (CIs). The study was prospectively registered with PROSPERO (CRD420251070176).

A total of five studies comprising 3,316 patients were included. Compared with interrupted anticoagulation, continued OAC was not associated with a statistically significant increase in major bleeding or major vascular complications. Continued OAC showed a borderline association with a lower risk of stroke, together with lower red blood cell transfusion and higher device success rates. However, given the limited number of studies, the predominance of retrospective evidence, and the trial sequential analysis findings, these results should be interpreted cautiously.

Continuation of OAC during TAVR appears feasible and was not associated with an increased risk of major bleeding or major vascular complications in the currently available evidence. Although continued OAC showed a possible association with lower stroke and transfusion risks, the evidence remains limited and statistically fragile. Larger randomized trials are needed before definitive clinical recommendations can be made.