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- Title
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.
- Authors
Ooi, Amanda Jia Qi; Wong, Chloe; Tan, Timothy Wei Ern; Ng, Trina Priscilla; Teo, Yao Neng; Teo, Yao Hao; Syn, Nicholas L.; Djohan, Andie H.; Lim, Yinghao; Yeo, Leonard L. L.; Tan, Benjamin Y. Q.; Chan, Mark Yan-Yee; Poh, Kian-Keong; Kong, William K. F.; Chai, Ping; Yeo, Tiong-Cheng; Yip, James W.; Kuntjoro, Ivandito; Sia, Ching-Hui
- 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).
- Subjects
ONLINE information services; MEDICAL databases; HEART valve prosthesis implantation; META-analysis; MEDICAL information storage &; retrieval systems; CONFIDENCE intervals; ORAL drug administration; SYSTEMATIC reviews; ATRIAL fibrillation; ANTICOAGULANTS; TREATMENT effectiveness; DESCRIPTIVE statistics; DATA analysis software; MEDLINE; PATIENT safety; VITAMIN K; CHEMICAL inhibitors
- Publication
European Journal of Clinical Pharmacology, 2022, Vol 78, Issue 10, p1589
- ISSN
0031-6970
- Publication type
Article
- DOI
10.1007/s00228-022-03371-6