Abstract 10273: The Use of Direct Oral Anticoagulation Therapy in Transcatheter Aortic Valve Implantation in Patients with Concurrent Indications for Anticoagulation; A Systematic Review and Meta-Analysis

Abstract

Introduction: The optimal antithrombotic regimen in patients after transcatheter aortic valve implantation (TAVI) in the setting of concurrent indication for anticoagulation remains unclear. Recently multiple studies have investigated the role of direct oral anticoagulation therapy (DOAC) in comparison to Vitamin K antagonist (VKA) in this category of patients. Therefore, we conducted a systematic review and meta-analysis to evaluate the efficacy and safety of this approach Hypothesis: DOAC is a safe and effective alternative anticoagulation therapy in TAVI patients Methods: Unrestricted search of the PubMed, EMBASE, and Cochrane databases from inception till June 1, 2021, for studies comparing DOAC with VKA in TAVR patients with concurrent indication for anticoagulation. Relevant data were extracted and analyzed using Revman 5.3 software. Relative Risk (RR) and 95% Confidence interval (CI) were calculated using the random-effects model. Results: A total of 8 studies (7 Observational, and 1 Randomized clinical trial) were included examining 4,158 TAVI patients (1,500 DOAC vs 2,658 VKA). There was no difference between DOAC and VKA in terms of all-cause mortality RR 0.89 (95% CI 0.65-1.21), all-bleeding events RR 0.90 (95% CI 0.76-1.07), and stroke risk RR 1.42 (95% CI 0.96-2.11). Conclusions: DOAC is probably non-inferior to VKA in TAVI patients with concurrent indications for anticoagulation therapy. Further studies are needed to validate our findings.