65 Anti-coagulants vs anti-platelets vs vitamin K in transcatheter aortic valve implantation, what to choose?: A network meta-analysis of randomized controlled trials

Abstract

<h3>Background</h3> Transcatheter aortic valve implantation (TAVI) shown its efficacy to be mainstay treatment for aortic valve diseases over surgical options, yet postoperative antiplatelet regimen after TAVI is still debatable. Thus, the aim of our network is to further investigate the safety and efficacy of direct oral anti-coagulants (DOAC) vs single- antiplatelet therapies (SAPTs) vs dual-antiplatelet therapies (DAPT) vs Vitamin K in patients undergoing Transcatheter aortic valve implantation. <h3>Methods</h3> PubMed, Web of Science, Scopus, and Embase, were systematically searched from inception to December 2022. A frequinest network meta-analysis has been conducted using random-effects method model calculating the risk ratio (OR) with a 95% confidence interval (CI). <h3>Results</h3> 9,087 patients from 11 studies were included. Regarding short-term outcomes, compared to DOAC, DAPT, SAPT, and vitamin K all were associated with a significantly lower odds for all-cause mortality with OR [0.66; 95% CI 0.46-0.86], [0.44; 95% CI 0.29-0.60], [0.64; 95% CI 0.31, 0.94], respectively (Fig 1A). Although, none of the interventions has statistically significant difference over DOAC in terms of cardiovascular death (Fig 1B), DAPT was associated with statistically significant more than 2 folds high odds for major vascular bleeding with OR [2.66; 95% CI 1.46-3.86]. Furthermore, regarding long term outcomes, both DAPT and SAPT was associated with a significantly higher bleeding rates with OR [1.78; 95% CI, 1.15-2.41] and [2.32; 95% CI, 1.29-3.35], respectively yet vitamin K was associated lower bleeding rates with OR [0.61; 95% CI, 0.24-0.98]. No intervention showed significance difference over DOAC in terms of all-cause mortality, cardiovascular mortality, and stroke (Fig 1C) except for DAPT which showed higher odds of long-term all-cause mortality OR [1.83; 95% CI, 1.29-2.37]. <h3>Conclusions</h3> Although having long term high rates of major vascular bleeding, SAPT proven its efficacy in having lower both short term and long-term all-cause mortality compared to DAPT which have both short and long term major vascular bleeding and higher long-term all-cause mortality. Vitamin K has lower rates of both short-term all-cause death and long term major vascular bleeding yet without significance in other outcomes. <h3>Conflict of Interest</h3> None to report