A systematic review and meta-analysis of non-vitamin K antagonist oral anticoagulants vs vitamin K antagonists after transcatheter aortic valve replacement in patients with atrial fibrillation.
Eur J Clin Pharmacol
; 78(10): 1589-1600, 2022 Oct.
Article
en En
| MEDLINE
| ID: mdl-35941300
ABSTRACT
PURPOSE:
Transcatheter aortic valve replacement (TAVR) is increasingly carried out in patients with aortic valvular conditions. Atrial fibrillation (AF) is a common comorbidity among patients undergoing TAVR. Despite this, there remains a paucity of data and established guidelines regarding anticoagulation use post-TAVR in patients with AF.METHODS:
Four databases were searched from inception until 12 October 2021. A title and abstract sieve, full-text review and data extraction were conducted by independent authors, and articles including patients without AF were excluded. The Review Manager (Version 5.4) was utilised in data analysis.RESULTS:
A total of 25,199 post-TAVR patients with AF were included from seven articles, with 9764 patients on non-vitamin K antagonist oral anticoagulants (NOAC) and 15,435 patients on vitamin K antagonists (VKA). In this analysis, there was a significantly lower risk of all-cause mortality at 1 year (RR 0.75, CI 0.58-0.97, p = 0.04, I2 = 56%), and bleeding at 1 year (RR 0.73, CI 0.68-0.79, p = < 0.00001, I2 = 0%), between patients on NOAC and VKA. There were no detectable differences between patients on NOAC and VKA for all-cause mortality at 2 years, stroke within 30 days, stroke within 1 year, ischaemic stroke at 1 year and life-threatening bleeding at 30 days.CONCLUSION:
While the results of this analysis reveal NOAC as a potential alternate treatment modality to VKA in post-TAVR patients with AF, further research is needed to determine the full safety and efficacy profile of NOAC (PROSPERO CRD42021283548).Palabras clave
Texto completo:
1
Bases de datos:
MEDLINE
Asunto principal:
Fibrilación Atrial
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Isquemia Encefálica
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Accidente Cerebrovascular
/
Reemplazo de la Válvula Aórtica Transcatéter
Tipo de estudio:
Guideline
/
Systematic_reviews
Límite:
Humans
Idioma:
En
Revista:
Eur J Clin Pharmacol
Año:
2022
Tipo del documento:
Article
País de afiliación:
Singapur