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Comparison of efficacy and safety between VKAs and DOACs in patients with atrial fibrillation after transcatheter aortic valve replacement: A systematic review and meta‐analysis

In the past decade, direct oral anticoagulants (DOACs) have proven to be the best option for patients with nonvalvular atrial fibrillation. Nevertheless, evidence for the use of DOACs for anticoagulation in valvular atrial fibrillation, particularly after aortic valve replacement, remains inadequate...

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Autores principales: Yan, Jie, Liu, Ming, Zhang, Yu, Yang, Danning, An, Fengshuang
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9574758/
https://www.ncbi.nlm.nih.gov/pubmed/36030549
http://dx.doi.org/10.1002/clc.23909
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author Yan, Jie
Liu, Ming
Zhang, Yu
Yang, Danning
An, Fengshuang
author_facet Yan, Jie
Liu, Ming
Zhang, Yu
Yang, Danning
An, Fengshuang
author_sort Yan, Jie
collection PubMed
description In the past decade, direct oral anticoagulants (DOACs) have proven to be the best option for patients with nonvalvular atrial fibrillation. Nevertheless, evidence for the use of DOACs for anticoagulation in valvular atrial fibrillation, particularly after aortic valve replacement, remains inadequate. Thus, we conducted a meta‐analysis to compare the efficacy and safety of vitamin K antagonists (VKAs) and DOACs in patients with atrial fibrillation after transcatheter aortic valve replacement (TAVR). We conducted a comprehensive search of online databases, and 11 studies were included in the final analysis. The primary endpoint was all‐cause mortality. Secondary endpoints included stroke and cardiovascular death. The safe endpoint is major and/or life‐threatening bleeding. Subgroup analysis was conducted according to the different follow‐up time of each study. Random‐effects models were used for all outcomes. Statistical heterogeneity was assessed using χ (2) tests and quantified using I (2) statistics. Patients in the DOACs group had a significantly lower risk of all‐cause mortality compared with patients in the VKAs group (relative risk [RR]: 1.20, 95% confidence interval [CI]: 1.01–1.43, p = .04). This benefit may be greater with longer follow‐up. In a subgroup analysis based on the length of follow‐up, a significantly lower risk of all‐cause mortality was found in the DOACs group in the subgroup with a follow‐up time of >12 months (RR: 1.50, 95% CI: 1.07–2.09, p = .001). There were no significant differences between the two groups in cardiovascular death, stroke, and major and/or life‐threatening bleeding. For patients with atrial fibrillation after TAVR, the use of DOACs may be superior to VKAs, and the benefit may be greater with longer follow‐up. The anticoagulant strategy for atrial fibrillation after TAVR is a valuable direction for future research.
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spelling pubmed-95747582022-10-17 Comparison of efficacy and safety between VKAs and DOACs in patients with atrial fibrillation after transcatheter aortic valve replacement: A systematic review and meta‐analysis Yan, Jie Liu, Ming Zhang, Yu Yang, Danning An, Fengshuang Clin Cardiol Reviews In the past decade, direct oral anticoagulants (DOACs) have proven to be the best option for patients with nonvalvular atrial fibrillation. Nevertheless, evidence for the use of DOACs for anticoagulation in valvular atrial fibrillation, particularly after aortic valve replacement, remains inadequate. Thus, we conducted a meta‐analysis to compare the efficacy and safety of vitamin K antagonists (VKAs) and DOACs in patients with atrial fibrillation after transcatheter aortic valve replacement (TAVR). We conducted a comprehensive search of online databases, and 11 studies were included in the final analysis. The primary endpoint was all‐cause mortality. Secondary endpoints included stroke and cardiovascular death. The safe endpoint is major and/or life‐threatening bleeding. Subgroup analysis was conducted according to the different follow‐up time of each study. Random‐effects models were used for all outcomes. Statistical heterogeneity was assessed using χ (2) tests and quantified using I (2) statistics. Patients in the DOACs group had a significantly lower risk of all‐cause mortality compared with patients in the VKAs group (relative risk [RR]: 1.20, 95% confidence interval [CI]: 1.01–1.43, p = .04). This benefit may be greater with longer follow‐up. In a subgroup analysis based on the length of follow‐up, a significantly lower risk of all‐cause mortality was found in the DOACs group in the subgroup with a follow‐up time of >12 months (RR: 1.50, 95% CI: 1.07–2.09, p = .001). There were no significant differences between the two groups in cardiovascular death, stroke, and major and/or life‐threatening bleeding. For patients with atrial fibrillation after TAVR, the use of DOACs may be superior to VKAs, and the benefit may be greater with longer follow‐up. The anticoagulant strategy for atrial fibrillation after TAVR is a valuable direction for future research. John Wiley and Sons Inc. 2022-08-28 /pmc/articles/PMC9574758/ /pubmed/36030549 http://dx.doi.org/10.1002/clc.23909 Text en © 2022 The Authors. Clinical Cardiology published by Wiley Periodicals, LLC. https://creativecommons.org/licenses/by/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
spellingShingle Reviews
Yan, Jie
Liu, Ming
Zhang, Yu
Yang, Danning
An, Fengshuang
Comparison of efficacy and safety between VKAs and DOACs in patients with atrial fibrillation after transcatheter aortic valve replacement: A systematic review and meta‐analysis
title Comparison of efficacy and safety between VKAs and DOACs in patients with atrial fibrillation after transcatheter aortic valve replacement: A systematic review and meta‐analysis
title_full Comparison of efficacy and safety between VKAs and DOACs in patients with atrial fibrillation after transcatheter aortic valve replacement: A systematic review and meta‐analysis
title_fullStr Comparison of efficacy and safety between VKAs and DOACs in patients with atrial fibrillation after transcatheter aortic valve replacement: A systematic review and meta‐analysis
title_full_unstemmed Comparison of efficacy and safety between VKAs and DOACs in patients with atrial fibrillation after transcatheter aortic valve replacement: A systematic review and meta‐analysis
title_short Comparison of efficacy and safety between VKAs and DOACs in patients with atrial fibrillation after transcatheter aortic valve replacement: A systematic review and meta‐analysis
title_sort comparison of efficacy and safety between vkas and doacs in patients with atrial fibrillation after transcatheter aortic valve replacement: a systematic review and meta‐analysis
topic Reviews
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9574758/
https://www.ncbi.nlm.nih.gov/pubmed/36030549
http://dx.doi.org/10.1002/clc.23909
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