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Post-Transcatheter Aortic Valve Replacement Antithrombotic Treatment in Nonindicated Patients: Updated Systematic Review and Network Meta-Analysis Publisher



Siami S1, 2 ; Kazemian S1 ; Maleki S1 ; Ebrahimi E1 ; Jodeiri F1, 2 ; Ebrahimzade M3 ; Hajiqasemi M3 ; Ebrahimi S3, 4 ; Mehdizadeh M1 ; Aghaei M2 ; Bastan MM1 ; Fathian Sabet M5 ; Nazari R6 ; Ebrahimi P1 Show All Authors
Authors
  1. Siami S1, 2
  2. Kazemian S1
  3. Maleki S1
  4. Ebrahimi E1
  5. Jodeiri F1, 2
  6. Ebrahimzade M3
  7. Hajiqasemi M3
  8. Ebrahimi S3, 4
  9. Mehdizadeh M1
  10. Aghaei M2
  11. Bastan MM1
  12. Fathian Sabet M5
  13. Nazari R6
  14. Ebrahimi P1
  15. Rana JS7, 8
  16. Nanna MG9
  17. Giri J10
  18. Kolte D11, 12
  19. Bieringsorensen T13
  20. Alkhouli M14
  21. Hosseini K1

Source: JACC: Advances Published:2025


Abstract

Background: The optimal antithrombotic strategy following transcatheter aortic valve replacement (TAVR) remains controversial. Objectives: The authors aimed to determine the safety and efficacy of various antithrombotic regimens in patients without an indication for anticoagulation following TAVR. Methods: We conducted a systematic search in PubMed, Embase, Scopus, and ClinicalTrials.gov until August 2024 for studies investigating antithrombotic regimens after TAVR in patients without an indication for chronic oral anticoagulation. The analysis compared single antiplatelet therapy (SAPT), dual antiplatelet therapy (DAPT), direct oral anticoagulants, and oral anticoagulant (OAC) plus SAPT. A frequentist network meta-analysis was employed to evaluate the post-TAVR risk of all-cause mortality, cardiovascular mortality, myocardial infarction, stroke, total bleeding, and life-threatening or major bleeding. Results: Eleven studies (8 randomized controlled trials and 3 propensity score-matched cohorts) comprising 5,821 patients undergoing TAVR were included. SAPT significantly reduced the risk of life-threatening/major bleeding compared with DAPT (OR: 0.53; 95% CI: 0.35-0.80), OAC (OR: 0.52; 95% CI: 0.28-0.99), and OAC + SAPT (OR: 0.32; 95% CI: 0.13-0.76). No significant differences were observed in the risk of cardiovascular mortality, stroke, or myocardial infarction between antithrombotic regimens. Subgroup analysis indicated an increased risk of mortality with low-dose rivaroxaban+3-month SAPT compared with SAPT (OR: 0.56; 95% CI: 0.35-0.89) and DAPT (OR: 0.58; 95% CI: 0.38-0.88). Meta-regression identified chronic obstructive pulmonary disease as the only significant modifier of bleeding risk following TAVR. Conclusions: Our findings support current guidelines recommending SAPT as the preferred antithrombotic strategy post-TAVR in patients without an indication for anticoagulation, demonstrating optimal safety without compromising efficacy. © 2025 The Authors
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