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Abstract
Background: The efficacy and safety of novel oral anticoagulants (NOACs) compared to the current guideline-recommended vitamin K antagonists (VKAs) in atrial fibrillation (AF) patients undergoing transcatheter aortic valve replacement (TAVR) has not been well established. We pooled evidence from all available studies to assess the risks and benefits of this drug class. Methods: We queried electronic databases (MEDLINE, Scopus, and Cochrane central) up until 15 th May 2021 for studies comparing NOACs to VKAs in AF patients undergoing TAVR. Results from studies were presented as risk ratios (RR) with 95% confidence intervals (CI) and pooled using a random-effects model. Subgroup analysis by study design and meta-regression analysis were performed to explore heterogeneity. Results: A total of 12 studies (4 RCTs and 8 retrospective observational) containing 13,815 patients (mean age 81.1 years; 50.1% men) were identified and included in the analysis. Pooled analysis revealed no significant difference between NOACs and VKAs in terms of stroke or systemic embolism (RR 0.83; p=0.34), major bleeding (RR 0.84; p=0.30), intracranial hemorrhage (RR 0.72; p=0.60), all-cause mortality (RR 0.71; p=0.15), and myocardial infarction (RR 1.34; p=0.32) at a mean length of follow-up of 15.1 months. RCTs and observational studies did not significantly differ across outcomes on subgroup analysis. Meta-regression analysis found heterogeneity in all-cause mortality to be significantly explained by percentage of males (coefficient: 0.049, p=0.007), mean age (coefficient: 0.221, p<0.001), and CHA2DS2-VASc score (coefficient: -1.657, p<0.001). Conclusions: This meta-analysis suggests that outcomes with NOACs do not significantly differ compared to VKAs following TAVR in patients with AF. Future RCTs may help provide a clearer answer.
Published Version
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