Efficacy and Safety of NOACs Compared With VKAs for Patients With Atrial Fibrillation After Transcatheter Aortic Valve Implantation: A System Review and Meta-Analysis

• Published in: Clinical and Applied Thrombosis/Hemostasis Vol. 28; p. 10760296221145168
• Main Authors: Ge, Junye, Han, Wenqiang, Ma, Chuanzhen, Maduray, Kellina, Chen, Tongshuai, Zhong, Jingquan
• Format: Book Review Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01.01.2022; SAGE PUBLICATIONS, INC; SAGE Publishing
• Subjects: Administration, Oral; Anticoagulants - therapeutic use; Atrial Fibrillation - drug therapy; Cardiac arrhythmia; Fibrinolytic Agents - therapeutic use; Humans; Meta-analysis; Review; Stroke; Stroke - drug therapy; Stroke - etiology; Stroke - prevention & control; Transcatheter Aortic Valve Replacement - adverse effects; Vitamin K; transcatheter aortic valve implantation; atrial fibrillation; anticoagulant; novel oral anticoagulant; vitamin K antagonist
• ISSN: 1076-0296; 1938-2723
• DOI: 10.1177/10760296221145168

Novel oral anticoagulants (NOACs) are preferentially recommended in patients with nonvalvular atrial fibrillation (AF) for stroke prevention over vitamin K antagonists (VKAs). However, the evidence regarding the efficacy and safety of NOACs versus VKAs after transcatheter aortic valve implantation (TAVI) in patients with AF is very rare. Pubmed, Embase, Web of science, and Cochrane Databases were searched for eligible studies published before May 19, 2022. A total of 11 studies were included in this meta-analysis involving 27 107 patients. Regarding primary outcomes, there were no differences between NOACs and VKAs in all-cause mortality (RR: 0.84, 95% CI: (0.69, 1.02)) and stroke (RR: 1.00, 95% CI: (0.85, 1.19)). With respect to secondary outcomes, NOACs were associated with reduced incidence of bleeding (RR: 0.77, 95% CI: (0.71, 0.83)) and intracranial bleeding (RR: 0.57, 95% CI: (0.39, 0.83)), whereas no significant differences were found in major or life-threatening bleeding (RR: 0.98, 95% CI: (0.82, 1.17)) and myocardial infarction (RR: 1.37, 95% CI: (0.83, 2.26)). Our meta-analysis revealed the safety and efficacy of NOACs may be superior to VKAs in AF patients undergoing TAVI.