Safety of non-vitamin K antagonist oral anticoagulants on outcomes after transcatheter aortic valve replacement: An updated meta-analysis

Authors

Aman Goyal, Department of Internal Medicine, Seth Gordhandas Sunderdas (GS) Medical College and King Edward Memorial (KEM) Hospital, Mumbai, IND.
Mahammed Khan Suheb, Department of Critical Care Medicine, Aurora St. Luke's Medical Center, Milwaukee, USA.Follow
Humza Saeed, Department of Internal Medicine, Rawalpindi Medical University, Rawalpindi, PAK.
Mah I. Changez, Department of Cardiothoracic Surgery, Yale University, New Haven, USA.
Muhammad Daoud Tariq, Department of Internal Medicine, Foundation University Medical College, Islamabad, PAK.
Viraj Shah, Department of Cardiology, Medical College of Georgia, Augusta University, Augusta, USA.
Fatima Q. Abbasi, Department of Internal Medicine, Pakistan Institute of Medical Sciences, Islamabad, PAK.
Laveeza Fatima, Department of Internal Medicine, Allama Iqbal Medical College, Lahore, PAK.
Hritvik Jain, Department of Internal Medicine, All India Institute of Medical Sciences, Jodhpur, Jodhpur, IND.
Sidhartha G. Senapati, Department of Internal Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, USA.
Vamsikalyan Borra, Department of Internal Medicine, The University of Texas Rio Grande Valley, Edinburg, USA.

Recommended Citation

Goyal A, Khan Suheb M, Saeed H, et al. Safety of Non-vitamin K Antagonist Oral Anticoagulants on Outcomes After Transcatheter Aortic Valve Replacement: An Updated Meta-Analysis. Cureus. 2024;16(10):e72267. Published 2024 Oct 24. doi:10.7759/cureus.72267

Affiliations

Aurora St. Luke's Medical Center

Abstract

The existing evidence on the use of non-vitamin K oral anticoagulants (NOACs) after transcatheter aortic valve replacement (TAVR) surgery is inconclusive and contradictory. Likewise, major society guidelines remain ambivalent about NOAC use around the time of TAVR. The objective of our meta-analysis was to assess the efficacy of NOACs in comparison to vitamin K antagonists (VKAs) in lowering complications following TAVR. An electronic literature search was conducted using MEDLINE, EMBASE, the international clinical trials database, and Cochrane Library. The primary endpoint was all-cause mortality, and the secondary endpoints included cardiovascular-related death, myocardial infarction, all-cause stroke, and various bleeding events. Forest plots were constructed for the pooled analysis of data. Subgroup and sensitivity analyses were also performed. No significant difference was noted between the NOAC and VKA groups with respect to the risk of all-cause mortality (14.14% vs. 20.28%; risk ratio (RR): 0.82; 95% confidence interval (CI): 0.61 to 1.10; p = 0.18), cardiovascular-related deaths (6.10% vs. 8.55%; RR: 1.02; 95% CI: 0.78 to 1.33; p = 0.91), myocardial infarction (1.52% vs. 2.51%; RR: 1.13; 95% CI: 0.50 to 2.56; p = 0.77), all-cause stroke (2.74% vs. 2.68%; RR: 1.02; 95% CI: 0.75 to 1.39; p = 0.89), major bleeding (7.74% vs. 9.62%; RR: 0.97; 95% CI: 0.58 to 1.61; p = 0.90), minor clinically relevant bleeding (14.33% vs. 13.73%; RR: 0.91; 95% CI: 0.67 to 1.24; p = 0.55), and other bleeding events. The risk of intracranial hemorrhage was lower in the NOAC group than in the VKA group (0.45% vs. 0.67%; RR: 0.61; 95% CI: 0.42 to 0.88; p = 0.008). Our study found NOACs to be non-inferior to VKAs in several outcomes, such as all-cause mortality, cardiovascular-related deaths, myocardial infarction, all-cause stroke, and bleeding events. In fact, NOACs were favored over VKAs, as the VKA group had a higher risk of developing intracranial hemorrhage.

Document Type

Article

PubMed ID

39583502