Antithrombotic Therapy and Cardiovascular Outcomes After Transcatheter Aortic Valve Implantation in Patients Without Indications for Chronic Oral Anticoagulation: A systematic review and network meta-analysis of randomized controlled trials

Kód výsledku v IS VaVaI

<a href="https://www.isvavai.cz/riv?ss=detail&h=RIV%2F00064173%3A_____%2F23%3A43925034" target="_blank" >RIV/00064173:_____/23:43925034 - isvavai.cz</a>

Nalezeny alternativní kódy

RIV/00216208:11120/23:43925034

Výsledek na webu

<a href="https://doi.org/10.1093/ehjcvp/pvad003" target="_blank" >https://doi.org/10.1093/ehjcvp/pvad003</a>

DOI - Digital Object Identifier

<a href="http://dx.doi.org/10.1093/ehjcvp/pvad003" target="_blank" >10.1093/ehjcvp/pvad003</a>

Jazyk výsledku

angličtina

Název v původním jazyce

Antithrombotic Therapy and Cardiovascular Outcomes After Transcatheter Aortic Valve Implantation in Patients Without Indications for Chronic Oral Anticoagulation: A systematic review and network meta-analysis of randomized controlled trials

Popis výsledku v původním jazyce

AIMS: As the antithrombotic regimen which may best prevent ischemic complications along with the lowest bleeding risk offset following transcatheter aortic valve implantation (TAVI) remains unclear, we aimed to compare the safety and efficacy of antithrombotic regimens in patients without having an indication for chronic oral anticoagulation. METHODS AND RESULTS: We conducted a Prospero-registered (CRD42021247924) systematic review and network meta-analysis of randomized controlled trials evaluating post-TAVI antithrombotic regimens up to April 2022. We estimated the relative risk (RR) and 95% confidence intervals (95%CI) using a random-effects model in a frequentist pairwise and network metanalytic approach. We included 7 studies comprising of 4 006 patients with a mean weighted follow-up of 12.9 months. Risk of all-cause death was significantly reduced with dual antiplatelet therapy (DAPT) compared to low-dose rivaroxaban + 3-month single antiplatelet therapy (SAPT) (RR 0.60, 95%CI 0.41-0.88) while no significant reduction was observed with SAPT versus DAPT (RR 1.02 95%CI 0.67-1.58) and SAPT and DAPT compared to apixaban or edoxaban (RR:0.60 95%CI:0.32-1.14 and RR:0.59 95%CI 0.34-1.02, respectively). SAPT was associated with a significant reduction of life-threatening, disabling, or major bleeding compared to DAPT (RR 0.45 95%CI 0.29-0.70), apixaban or edoxaban alone (RR 0.45, 95%CI 0.25-0.79) and low-dose rivaroxaban + 3-month SAPT (RR 0.30, 95%CI 0.16-0.57). There were no differences between the various regimens with respect to myocardial infarction, stroke, or systemic embolism. CONCLUSION: Following TAVI in patients without an indication for chronic oral anticoagulant, SAPT more than halved the risk of bleeding compared to DAPT and direct oral anticoagulant-based regimens without significant ischemic offset.

Název v anglickém jazyce

Antithrombotic Therapy and Cardiovascular Outcomes After Transcatheter Aortic Valve Implantation in Patients Without Indications for Chronic Oral Anticoagulation: A systematic review and network meta-analysis of randomized controlled trials

Popis výsledku anglicky

AIMS: As the antithrombotic regimen which may best prevent ischemic complications along with the lowest bleeding risk offset following transcatheter aortic valve implantation (TAVI) remains unclear, we aimed to compare the safety and efficacy of antithrombotic regimens in patients without having an indication for chronic oral anticoagulation. METHODS AND RESULTS: We conducted a Prospero-registered (CRD42021247924) systematic review and network meta-analysis of randomized controlled trials evaluating post-TAVI antithrombotic regimens up to April 2022. We estimated the relative risk (RR) and 95% confidence intervals (95%CI) using a random-effects model in a frequentist pairwise and network metanalytic approach. We included 7 studies comprising of 4 006 patients with a mean weighted follow-up of 12.9 months. Risk of all-cause death was significantly reduced with dual antiplatelet therapy (DAPT) compared to low-dose rivaroxaban + 3-month single antiplatelet therapy (SAPT) (RR 0.60, 95%CI 0.41-0.88) while no significant reduction was observed with SAPT versus DAPT (RR 1.02 95%CI 0.67-1.58) and SAPT and DAPT compared to apixaban or edoxaban (RR:0.60 95%CI:0.32-1.14 and RR:0.59 95%CI 0.34-1.02, respectively). SAPT was associated with a significant reduction of life-threatening, disabling, or major bleeding compared to DAPT (RR 0.45 95%CI 0.29-0.70), apixaban or edoxaban alone (RR 0.45, 95%CI 0.25-0.79) and low-dose rivaroxaban + 3-month SAPT (RR 0.30, 95%CI 0.16-0.57). There were no differences between the various regimens with respect to myocardial infarction, stroke, or systemic embolism. CONCLUSION: Following TAVI in patients without an indication for chronic oral anticoagulant, SAPT more than halved the risk of bleeding compared to DAPT and direct oral anticoagulant-based regimens without significant ischemic offset.

Druh

J_imp - Článek v periodiku v databázi Web of Science

CEP obor

—

OECD FORD obor

30201 - Cardiac and Cardiovascular systems

Projekt

—

Návaznosti

N - Vyzkumna aktivita podporovana z neverejnych zdroju

Rok uplatnění

2023

Kód důvěrnosti údajů

S - Úplné a pravdivé údaje o projektu nepodléhají ochraně podle zvláštních právních předpisů

Název periodika

European Heart Journal: Cardiovascular Pharmacotherapy

ISSN

2055-6837

e-ISSN

2055-6845

Svazek periodika

9

Číslo periodika v rámci svazku

3

Stát vydavatele periodika

GB - Spojené království Velké Británie a Severního Irska

Počet stran výsledku

11

Strana od-do

251-261

Kód UT WoS článku

000930545100001

EID výsledku v databázi Scopus

2-s2.0-85148095701