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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

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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).

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Data availability

Data sharing is not applicable to this article as no datasets were generated or analysed during the current study.

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Funding

Ching-Hui Sia was supported by the National University of Singapore Yong Loo Lin School of Medicine’s Junior Academic Faculty Scheme.

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Author notes

  1. Amanda Jia Qi Ooi, Chloe Wong, Timothy Wei Ern Tan and Trina Priscilla Ng have contributed equally to this paper.

Authors and Affiliations

  1. Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

    Amanda Jia Qi Ooi, Chloe Wong, Timothy Wei Ern Tan, Trina Priscilla Ng, Yao Neng Teo, Yao Hao Teo, Nicholas L. Syn, Leonard L. L. Yeo, Benjamin Y. Q. Tan, Mark Yan-Yee Chan, Kian-Keong Poh, William K. F. Kong, Ping Chai, Tiong-Cheng Yeo, James W. Yip & Ching-Hui Sia

  2. Department of Cardiology, National University Heart Centre, Singapore, 119228, Singapore

    Andie H. Djohan, Yinghao Lim, Mark Yan-Yee Chan, Kian-Keong Poh, William K. F. Kong, Ping Chai, Tiong-Cheng Yeo, James W. Yip, Ivandito Kuntjoro & Ching-Hui Sia

  3. Division of Neurology, Department of Medicine, National University Hospital, Singapore, Singapore

    Leonard L. L. Yeo & Benjamin Y. Q. Tan

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Contributions

Conceptualization, Amanda Jia Qi Ooi, Chloe Wong, Timothy Wei Ern Tan, Trina Priscilla Ng, Yao Neng Teo, Yao Hao Teo, Nicholas L. Syn, Andie H. Djohan, Yinghao Lim, Leonard L. L. Yeo, Benjamin Y. Q. Tan, Mark Yan-Yee Chan, Kian-Keong Poh, William K. F. Kong, Ping Chai, Tiong-Cheng Yeo, James W. Yip, Ivandito Kuntjoro and Ching-Hui Sia. Methodology, Amanda Jia Qi Ooi, Chloe Wong, Timothy Wei Ern Tan, Trina Priscilla Ng, Yao Neng Teo, Yao Hao Teo, Nicholas L. Syn, Andie H. Djohan, Yinghao Lim, Leonard L. L. Yeo, Benjamin Y. Q. Tan, Mark Yan-Yee Chan, Kian-Keong Poh, William K. F. Kong, Ping Chai, Tiong-Cheng Yeo, James W. Yip, Ivandito Kuntjoro and Ching-Hui Sia. Formal analysis and investigation, Amanda Jia Qi Ooi, Chloe Wong, Timothy Wei Ern Tan, Trina Priscilla Ng, Yao Neng Teo, Yao Hao Teo, Nicholas L. Syn, Andie H. Djohan, Yinghao Lim, Leonard L. L. Yeo, Benjamin Y. Q. Tan, Mark Yan-Yee Chan, Kian-Keong Poh, William K. F. Kong, Ping Chai, Tiong-Cheng Yeo, James W. Yip, Ivandito Kuntjoro and Ching-Hui Sia. Writing — original draft preparation, Amanda Jia Qi Ooi, Chloe Wong, Timothy Wei Ern Tan, Trina Priscilla Ng and Ching-Hui Sia. Writing — review and editing, Amanda Jia Qi Ooi, Chloe Wong, Timothy Wei Ern Tan, Trina Priscilla Ng, Yao Neng Teo, Yao Hao Teo, Nicholas L. Syn, Andie H. Djohan, Yinghao Lim, Leonard L. L. Yeo, Benjamin Y. Q. Tan, Mark Yan-Yee Chan, Kian-Keong Poh, William K. F. Kong, Ping Chai, Tiong-Cheng Yeo, James W. Yip, Ivandito Kuntjoro and Ching-Hui Sia. Funding acquisition, Ching-Hui Sia. Resources, Ching-Hui Sia. Supervision, Ching-Hui Sia.

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Ooi, A.J.Q., Wong, C., Tan, T.W.E. et al. 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, 1589–1600 (2022). https://doi.org/10.1007/s00228-022-03371-6

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