Abstract 13992: Antiplatelet Therapy Reduces Mortality When Compared to Direct Oral Anticoagulants in Post-Transcatheter Aortic Valve Replacement Patients Without Any Indication for Anticoagulation

Abstract

Introduction: Transcatheter Aortic Valve Replacement (TAVR) is a widely used minimally invasive treatment for severe aortic stenosis. Though the procedure is safe and effective, patients are still at risk for ischemic and hemorrhagic events after this intervention. The post-procedure antithrombotic management in these patients continues to be a source of debate, particularly in patients who do not have a preexisting or concurrent comorbidity which requires long-term anticoagulation therapy. Methods: We performed a systematic review and meta-analysis to compare Direct Oral Anticoagulants (DOACs) versus antiplatelet therapy after TAVR in patients without previous indication for chronic oral anticoagulation. PubMed, EMBASE, and Cochrane databases were searched for randomized controlled trials (RCTs). Risk ratio (RR) with P value < 0.05 were considered statistically significant. The primary endpoints of interest were death, obstructive valve thrombosis and major bleeding. No time for follow-up was limited. Results: Three studies involving 2922 patients undergoing TAVR were included. Of the participants, 1459 received antiplatelets and 1463 received DOACs. Antiplatelets were associated with significantly lower all-cause mortality (RR 1.68 [1.22-2.30], 95%IC; p=0.001). Major bleeding did not differ significantly between groups, but DOACs had a higher risk of bleeding when compared to antiplatelet drugs (RR 1.44 [0.90-2.32]; 95%IC, p=0.13). The antiplatelet group had a significantly higher risk of valve thrombosis than the DOACs group (RR 0.27 [0.14-0.51]; 95%IC; p<0.0001). Conclusions: This meta-analysis suggests that the use of antiplatelet, in comparison to the DOACs, after the TAVR procedure, reduces all-cause mortality, without significantly increasing the risk of bleeding. However, DOACs have been shown to reduce valve thrombosis. This is the best current evidence available. More RCTs, however, are needed to consolidate these findings.