Post-TAVR patients with atrial fibrillation: are NOACs better than VKAs?-A meta-analysis

Lu Wang; Wanyue Sang; Yi Jian; Xiaoxue Zhang; Yafan Han; Feifei Wang; Liang Wang; Suxia Yang; Subinuer Wubulikasimu; Li Yang; Huaxin Sun; Yaodong Li

doi:10.3389/fcvm.2023.1175215

Post-TAVR patients with atrial fibrillation: are NOACs better than VKAs?-A meta-analysis

Front Cardiovasc Med. 2023 Aug 31:10:1175215. doi: 10.3389/fcvm.2023.1175215. eCollection 2023.

Authors

Lu Wang^#^{1

2}, Wanyue Sang^#^{1

2}, Yi Jian^{1

2}, Xiaoxue Zhang^{1

2}, Yafan Han^{1

2}, Feifei Wang^{1

2}, Liang Wang^{1

2}, Suxia Yang^{1

2}, Subinuer Wubulikasimu^{1

2}, Li Yang^{1

2}, Huaxin Sun^{1

2}, Yaodong Li^{1

2}

Affiliations

¹ Cardiac Pacing and Electrophysiology Department, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.
² Xinjiang Key Laboratory of Cardiac Electrophysiology and Cardiac Remodeling, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.

^# Contributed equally.

Abstract

Objective: This study aimed to compare the efficacy of novel oral anticoagulants (NOACs) with traditional anticoagulants vitamin K antagonists (VKAs) in patients with atrial fibrillation (AF) post transcatheter aortic valve replacement (TAVR).

Methods: Studies comparing the usage of NOACs and VKAs in AF patients with oral anticoagulant indication post-TAVR were retrieved from PubMed, EMBASE, Medline, and Cochrane databases from their building-up to Jan. 2023. The literature was screened in line of inclusion and exclusion criteria. Risk ratio (RR) or odds ratio (OR),95% confidence interval (CI) and number needed to treat (NNT) were calculated for four main indexes that composite endpoints composed mainly of any clinically relevant risk events, stroke, major bleeding, and all-cause mortality. Subsequently, a meta-analysis was performed using the RevMan5.3 and Stata 16.0 software.

Results: In the aggregate of thirteen studies, contained 30388 post-TAVR patients with AF, were included in this meta-analysis. Our results indicated that there was no significant difference in stroke between the NOACs group and the VKAs group, and the NOACs group had a numerically but non-significantly higher number of composite endpoint events compared with the other group. Nevertheless, the incidence of major bleeding [11.29% vs. 13.89%, RR 0.82, 95%CI (0.77,0.88), P < 0.00001, I² = 69%, NNT = 38] and all-cause mortality [14.18% vs. 17.61%, RR 0.83, 95%CI (0.79,0.88), p < 0.00001, I² = 82%, NNT = 29] were significantly lower in the NOACs group than another group.

Conclusion: Taken together, our data indicated that the usage of NOACs reduced the incidence of major bleeding and all-cause mortality compared to VKAs in post-TAVR patients with AF.

Keywords: anticoagulant therapy; atrial fibrillation; new oral anticoagulants; transcatheter aortic valve replacement; vitamin K antagonists.

Publication types

Review

Grants and funding

This work was supported by Natural Science Foundation of Xinjiang Uygur Autonomous Region (No. 2022D01E22) and Key R&D Program of Xinjiang Uygur Autonomous Region (No. 2022B03023).