Li Dongxu, Ma Xiaofang, Zhou Xu, Qian Yongjun
Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, China.
Department of Emergency Medicine, Emergency Medical Laboratory, West China Hospital, Sichuan University, Chengdu, China.
Front Pharmacol. 2022 Feb 11;13:755009. doi: 10.3389/fphar.2022.755009. eCollection 2022.
We aimed to compare non-vitamin K oral anticoagulants (NOACs) with a traditional antithrombotic such as vitamin K antagonist (VKA) and antiplatelet agents in patients after transcatheter aortic valve replacement (TAVR). We conducted a search in PubMed, EMBASE, and the Cochrane Library until November 2021 for studies involving comparisons of any type of NOACs, including dabigatran, apixaban, rivaroxaban, and edoxaban, with VKA or antiplatelet agents after TAVR. A comparison of NOACs versus VKA was performed in patients with an indication for oral anticoagulation. In addition, we compared NOACs versus antiplatelet in patients without such indication. We calculated the hazard ratios with 95% confidence intervals (CIs) to determine long-term outcomes. The primary outcome was a combined endpoint consisting of all-cause mortality, stroke, major bleeding, or any related clinical adverse events. Secondary outcomes were all-cause mortality, major bleeding, and stroke, respectively. A total of 10 studies including 10,563 patients after TAVR were included in this meta-analysis. There were no significant differences in any of the long-term outcomes between the NOAC and VKA groups. Although there were no significant differences in the combined endpoint, major bleeding, or stroke, a significant difference was observed in the all-cause mortality (HR 1.74, 95% CI 1.25-2.43, = 0.001) between the NOAC and antiplatelet groups. For patients with an indication for oral anticoagulation after TAVR, NOACs seem to be associated with noninferior outcomes compared with VKA therapy. However, for patients without an indication for oral anticoagulation, NOACs appear to be associated with a higher risk of all-cause death as compared with antiplatelet treatment. https://clinicaltrials.gov/, identifier CRD42020155122.
我们旨在比较经导管主动脉瓣置换术（TAVR）后患者使用非维生素K口服抗凝药（NOACs）与传统抗栓药物（如维生素K拮抗剂（VKA）和抗血小板药物）的效果。我们在PubMed、EMBASE和Cochrane图书馆进行检索，直至2021年11月，以查找涉及比较任何类型NOACs（包括达比加群、阿哌沙班、利伐沙班和依度沙班）与TAVR后VKA或抗血小板药物的研究。对有口服抗凝指征的患者进行了NOACs与VKA的比较。此外，我们还比较了无此指征患者中NOACs与抗血小板药物的效果。我们计算了95%置信区间（CIs）的风险比，以确定长期结局。主要结局是由全因死亡率、中风、大出血或任何相关临床不良事件组成的复合终点。次要结局分别是全因死亡率、大出血和中风。本荟萃分析共纳入了10项研究，涉及10563例TAVR后的患者。NOAC组和VKA组在任何长期结局方面均无显著差异。虽然在复合终点、大出血或中风方面无显著差异，但在全因死亡率方面，NOAC组和抗血小板组之间存在显著差异（HR 1.74，95% CI 1.25 - 2.43， = 0.001）。对于TAVR后有口服抗凝指征的患者，与VKA治疗相比，NOACs似乎与非劣效结局相关。然而，对于无口服抗凝指征的患者，与抗血小板治疗相比，NOACs似乎与全因死亡风险较高相关。https://clinicaltrials.gov/，标识符CRD42020155122。
