Tehran University of Medical Sciences

Science Communicator Platform

Stay connected! Follow us on X network (Twitter):
Share this content! On (X network) By
Post-Transcatheter Aortic Valve Replacement Antithrombotic Treatment in Nonindicated Patients: Updated Systematic Review and Network Meta-Analysis Publisher



Siami S1, 2 ; Kazemian S1 ; Maleki S1 ; Ebrahimi E1 ; Jodeiri F1, 2 ; Ebrahimzade M3 ; Hajiqasemi M3 ; Ebrahimi S3, 4 ; Mehdizadeh M1 ; Aghaei M2 ; Bastan MM1 ; Fathian Sabet M5 ; Nazari R6 ; Ebrahimi P1 Show All Authors
Authors
  1. Siami S1, 2
  2. Kazemian S1
  3. Maleki S1
  4. Ebrahimi E1
  5. Jodeiri F1, 2
  6. Ebrahimzade M3
  7. Hajiqasemi M3
  8. Ebrahimi S3, 4
  9. Mehdizadeh M1
  10. Aghaei M2
  11. Bastan MM1
  12. Fathian Sabet M5
  13. Nazari R6
  14. Ebrahimi P1
  15. Rana JS7, 8
  16. Nanna MG9
  17. Giri J10
  18. Kolte D11, 12
  19. Bieringsorensen T13
  20. Alkhouli M14
  21. Hosseini K1
Show Affiliations
Authors Affiliations
  1. 1. Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
  2. 2. School of Medicine, Islamic Azad University, Tehran Medical Branch, Tehran, Iran
  3. 3. School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  4. 4. Department of Cardiology, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
  5. 5. Department of Internal Medicine, McLaren Flint/Michigan State University (MSU), Flint, MI, United States
  6. 6. Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Modarres Hospital, Tehran, Iran
  7. 7. Division of Cardiology, Kaiser Permanente Northern California, Oakland, CA, United States
  8. 8. Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
  9. 9. Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, United States
  10. 10. Cardiovascular Medicine Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
  11. 11. Cardiology Division, Massachusetts General Hospital, Boston, MA, United States
  12. 12. Harvard Medical School, Boston, MA, United States
  13. 13. Department of Cardiology, Herlev and Gentofte University Hospital, Copenhagen, Denmark
  14. 14. Division of Cardiology, Mayo Clinic Hospital, Rochester, MN, United States

Source: JACC: Advances Published:2025


Abstract

Background: The optimal antithrombotic strategy following transcatheter aortic valve replacement (TAVR) remains controversial. Objectives: The authors aimed to determine the safety and efficacy of various antithrombotic regimens in patients without an indication for anticoagulation following TAVR. Methods: We conducted a systematic search in PubMed, Embase, Scopus, and ClinicalTrials.gov until August 2024 for studies investigating antithrombotic regimens after TAVR in patients without an indication for chronic oral anticoagulation. The analysis compared single antiplatelet therapy (SAPT), dual antiplatelet therapy (DAPT), direct oral anticoagulants, and oral anticoagulant (OAC) plus SAPT. A frequentist network meta-analysis was employed to evaluate the post-TAVR risk of all-cause mortality, cardiovascular mortality, myocardial infarction, stroke, total bleeding, and life-threatening or major bleeding. Results: Eleven studies (8 randomized controlled trials and 3 propensity score-matched cohorts) comprising 5,821 patients undergoing TAVR were included. SAPT significantly reduced the risk of life-threatening/major bleeding compared with DAPT (OR: 0.53; 95% CI: 0.35-0.80), OAC (OR: 0.52; 95% CI: 0.28-0.99), and OAC + SAPT (OR: 0.32; 95% CI: 0.13-0.76). No significant differences were observed in the risk of cardiovascular mortality, stroke, or myocardial infarction between antithrombotic regimens. Subgroup analysis indicated an increased risk of mortality with low-dose rivaroxaban+3-month SAPT compared with SAPT (OR: 0.56; 95% CI: 0.35-0.89) and DAPT (OR: 0.58; 95% CI: 0.38-0.88). Meta-regression identified chronic obstructive pulmonary disease as the only significant modifier of bleeding risk following TAVR. Conclusions: Our findings support current guidelines recommending SAPT as the preferred antithrombotic strategy post-TAVR in patients without an indication for anticoagulation, demonstrating optimal safety without compromising efficacy. © 2025 The Authors
Related Docs
1. When Direct Oral Anticoagulants Should Not Be Standard Treatment: Jacc State-Of-The-Art Review, Journal of the American College of Cardiology (2024)
2. Trends in Transcatheter Versus Surgical Aortic Valve Replacement Outcomes in Patients With Low-Surgical Risk: A Systematic Review and Meta-Analysis of Randomized Trials, Journal of the American Heart Association (2024)
3. A Case of Early Thrombosis Following a Percutaneous Tricuspid Valve in Valve Implantation Managed by Thrombolysis, Echocardiography (2022)
Experts (# of related papers)
View all Related Experts
Kaveh Hosseini (1)
Yaser Jenab (1)