757 DIRECT ORAL ANTICOAGULANTS OR VITAMIN K ANTAGONISTS IN AFTER TAVR

Abstract

Abstract Background Several patients undergoing transcatheter aortic valve replacement (TAVR) also require oral anticoagulation (OAC) for atrial fibrillation (AF) or deep vein thromboembolism. However, the optimal type of OAC strategy (direct oral anticoagulants, DOACs, or vitamin K antagonists, VKA) is still unclear in this setting. Method We performed systematic literature research and meta-analysis in PubMed, Medline, and EMBASE databases for studies reporting either all-cause mortality, major/life-threatening bleeding or stroke events. Results Ten observational studies and one randomized controlled trial (RCT), including 29,333 patients, were eligible for inclusion. Compared to VKA, DOACs use after TAVR was associated with a modest but significantly lower rates of all-cause mortality (RR 0.88; 95% CI: 0.78-0.99, p-value 0.04). Total stroke events (RR 0.97; 95% CI: 0.76-1.23, p-value 0.79) and major/life-threatening bleeding (RR 0.94; 95% CI: 0.70-1.27, p-value 0.69) were comparable among the two treatments. In the following sensitivity analysis including observational studies only, results in terms stroke events were consistent (RR 1.00;95% CI: 0.75-1.34, p-value 0.99) . However, the overall mortality was comparable between the two treatments (RR 0.88; 95% CI: 0.77-1.00, p-value 0.99), while major/life-threatening bleeding occurred less in the DOACs group (RR 0.80; 95% CI: 0.68-0.94, p-value 0.006). Conclusion Considering the totality of published evidence in TAVR patients with a concomitant indication for OAC, DOACs use was associated with reduced all-cause mortality and comparable major/life-threatening bleeding and stroke events compared to VKA.