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Thromb Haemost 2022; 122(02): 216-225
DOI: 10.1055/a-1496-8114
Cellular Haemostasis and Platelets

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

Eliano Pio Navarese
1   Department of Cardiology and Internal Medicine, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
,
Leonardo Grisafi
2   Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
3   Department of Thoracic, Heart and Vascular Diseases, Maggiore della Carità Hospital, Novara, Italy
,
Enrico Guido Spinoni
2   Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
3   Department of Thoracic, Heart and Vascular Diseases, Maggiore della Carità Hospital, Novara, Italy
,
Marco Giovanni Mennuni
3   Department of Thoracic, Heart and Vascular Diseases, Maggiore della Carità Hospital, Novara, Italy
,
Andrea Rognoni
3   Department of Thoracic, Heart and Vascular Diseases, Maggiore della Carità Hospital, Novara, Italy
,
Jakub Ratajczak
4   Department of Health Promotion, Nicolaus Copernicus University, Bydgoszcz, Poland
5   Department of Cardiology and Internal Medicine, Nicolaus Copernicus University, Bydgoszcz, Poland
,
Przemysław Podhajski
5   Department of Cardiology and Internal Medicine, Nicolaus Copernicus University, Bydgoszcz, Poland
,
Endrin Koni
6   Department of Interventional Cardiology, Santa Corona Hospital, Pietra Ligure, Italy
,
Jacek Kubica
1   Department of Cardiology and Internal Medicine, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
,
Giuseppe Patti 
2   Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
3   Department of Thoracic, Heart and Vascular Diseases, Maggiore della Carità Hospital, Novara, Italy
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Abstract

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), and OAC + SAPT. The mean follow-up was 15 months.

Results In comparison to DAPT, SAPT was associated with a 44% risk reduction of any bleeding (odds ratio [OR]: 0.56 [95% confidence interval, 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) versus OAC + SAPT.

Conclusion 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.

Keywords

TAVI - oral anticoagulation - antiplatelet therapy - bleeding events - mortality

Supplementary Material



Publication History

Received: 20 February 2021

Accepted: 27 April 2021

Accepted Manuscript online:
30 April 2021

Article published online:
15 June 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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