The predictive value of baseline pulmonary hypertension in early and long term cardiac and all-cause mortality after transcatheter aortic valve implantation for patients with severe aortic valve stenosis: A systematic review and meta-analysis

2018 ◽  
Vol 19 (7) ◽  
pp. 859-867 ◽  
Author(s):  
Damianos G. Kokkinidis ◽  
Christos A. Papanastasiou ◽  
Anil Kumar Jonnalagadda ◽  
Evangelos K. Oikonomou ◽  
Christina A. Theochari ◽  
...  
Keyword(s):  
Systematic Review ◽  
Pulmonary Hypertension ◽  
Aortic Valve ◽  
Predictive Value ◽  
Meta Analysis ◽  
Transcatheter Aortic Valve ◽  
All Cause Mortality ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Abstract 12786: Antithrombotic Therapy After Transcatheter Aortic Valve Implantation in Patients With Concomitant Indications for Long-term Oral Anticoagulation: A Systemic Review and Meta-analysis

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Gonçalo Costa ◽  
Lino Gonçalves ◽  
rogerio teixeira
Keyword(s):  
Aortic Valve ◽  
Oral Anticoagulation ◽  
Meta Analysis ◽  
Antithrombotic Treatment ◽  
Transcatheter Aortic Valve ◽  
Cerebrovascular Events ◽  
All Cause Mortality ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Background: Ischemic and bleeding complications after transcatheter aortic valve implantation (TAVI) remain prevalent and affect survival. Atrial fibrillation (AF) is common in patients undergoing TAVI and constitutes an indication for long-term oral anticoagulation (OAC). Current guidelines on antithrombotic treatment in patients who have an indication for OAC after TAVI are based on expert opinion and suggest the use of vitamin K antagonist (VKA) either alone or in combination with aspirin or clopidogrel. Purpose: To compare OAC (VKA or direct oral anticoagulant) versus OAC in combination with single antiplatelet therapy (SAPT), either aspirin or clopidogrel, as antithrombotic treatment following TAVI in patients with an indication for long-term OAC or the prevention of cerebrovascular events, bleeding events and all-cause mortality. Methods: We systematically searched PubMed, Embase and Cochrane databases, in April 2020, for both interventional or observational studies comparing OAC with OAC plus SAPT. Random-effects meta-analysis for OAC and OAC combined with SAPT were performed. Results: Four studies were included (three registry-based and one randomized clinical trial) providing a total of 1218 patients, and 69 pooled cerebrovascular events. There was no statistical difference between OAC and OAC plus SAPT for the prevention of cerebrovascular events after TAVI (pooled OR 0.89 [0.51, 1.55], P=0.69, I 2 = 0%) - Figure. Similarly, there was a similar rate of all-cause mortality (pooled OR 0.98 [0.72, 1.35], P=0.91, I 2 = 0%). Furthermore, the rate of major bleeding or life-threatening events was significantly lower for OAC compared with the combined therapy (pooled OR 0.45 [0.29, 0.70], P<0.01, I 2 = 5%). Conclusions: Our pooled data suggests that for patients with indication for long-term oral anticoagulation after TAVI, the routine use of double anti-thrombotic therapy (SAPT+OAC) compared to the use of OAC, conferred an increased risk of bleeding

scholarly journals Antithrombotic Therapy After Transcatheter Aortic Valve Implantation in Patients with Long-Term Indication for Anticoagulation: Systematic Review and Meta-Analysis

2020 ◽  
Author(s):  
Goncalo Ferraz Costa ◽  
Jose Sousa ◽  
Lino Goncalves ◽  
Rogerio Teixeira
Keyword(s):  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Controlled Trial ◽  
Meta Analysis ◽  
Severe Bleeding ◽  
Transcatheter Aortic Valve ◽  
All Cause Mortality ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Abstract Objective: The aim of this study was to compare antithrombotic regimens following transcatheter aortic valve implantation (TAVI) in patients requiring long-term oral anticoagulation (OAC). Methods: We systematically searched PubMed, Embase, and Cochrane databases for interventional and observational studies comparing OAC to OAC plus single antiplatelet therapy (SAPT). Results: Five studies were included (four registry-based and one randomized controlled trial), comprising a total of 1318 patients. Our meta-analysis revealed lower rates of severe bleeding (pooled odds ratio [OR] 0.46 [0.31, 0.69], P<0.01, I2=0%) and major bleeding (pooled OR 0.46 [0.27,0.79], P<0.01, I2=0%) for the OAC group than for the OAC-plus-SAPT group. There was a nonsignificant trend towards reduced life-threatening bleeding events in the OAC group (pooled OR 0.54 [0.27,1.08], P=0.08, I2=11%). There was no difference between groups in the risks of stroke (pooled OR 1.02 [0.58,1.80], P=0.58, I2= 0%) or all-cause mortality (pooled OR 1.04 [0.75,1.42], P=0.83, I2= 0%) after TAVI. Conclusions: Our pooled analysis suggests that for patients with an indication for long-term OAC after TAVI, double anti-thrombotic therapy, compared to OAC alone, increased the risk of bleeding without reducing cerebrovascular events and all-cause mortality.

Safety and Efficacy of Different Antithrombotic Strategies After Transcatheter Aortic Valve Implantation: A Network Meta-Analysis

2021 ◽  
Author(s):  
Eliano Pio Navarese ◽  
Leonardo Grisafi ◽  
Enrico Spinoni ◽  
Marco Giovanni Mennuni ◽  
Andrea Rognoni ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Antiplatelet Therapy ◽  
Major Bleeding ◽  
Meta Analysis ◽  
Transcatheter Aortic Valve ◽  
Safety Endpoint ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Background. The optimal pharmacological therapy after transcatheter aortic valve implantation (TAVI) remains uncertain. We compared efficacy and safety of various antiplatelet and anticoagulant approaches after TAVI by a network meta-analysis. Methods. A total of 14 studies (both observational and randomized) were considered, with 24,119 patients included. Primary safety endpoint was the incidence of any bleeding complications during follow-up. Secondary safety endpoint was major bleeding. Efficacy endpoints were stroke, myocardial infarction and cardiovascular mortality. A frequentist network meta-analysis was conducted with a random-effects model. The following strategies were compared: dual antiplatelet therapy (DAPT), single antiplatelet therapy (SAPT), oral anticoagulation (OAC), OAC+SAPT. Mean follow-up was 15 months. Results. In comparison to DAPT, SAPT was associated with a 44% risk reduction of any bleeding (OR, 0.56 [95% CI, 0.39-0.80]). SAPT was ranked as the safest strategy for the prevention of any bleeding (P-score, 0.704), followed by OAC alone (P-score, 0.476) and DAPT (P-score, 0.437). Consistent results were observed for major bleeding. The incidence of cardiovascular death and secondary ischemic endpoints did not differ among the tested antithrombotic approaches. In patients with indication for long-term anticoagulation, OAC alone showed similar rates of stroke (OR 0.92 [95% CI 0.41-2.05], p=0.83) and reduced occurrence of any bleeding (OR 0.49 [95% CI 0.37-0.66], p<0.01) vs OAC+SAPT. Conclusions. The present network meta-analysis supports after TAVI the use of SAPT in patients without indication for OAC and OAC alone in those needing long-term anticoagulation.

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