Atrial fibrillation (AF) is a common co-morbidity in patients undergoing transcatheter
aortic valve implantation (TAVI), but whether direct oral anticoagulants (DOACs) confer
similar safety and efficacy compared with vitamin K antagonist (VKA) remains unclear
in this population. The aim of our study was to investigate the safety and efficacy
of DOACs compared with VKA in patients undergoing TAVI with concomitant indication
of oral anticoagulation. PUBMED and EMBASE were searched through October 2019 for
studies comparing DOACs versus VKA in patients undergoing TAVI with indication of
oral anticoagulation. The main efficacy outcomes were all-cause mortality and stroke
whereas the main safety outcome was major and/or life-threatening bleeding. Our search
identified 5 eligible studies including 2,569 patients. Majority of patients had atrial
fibrillation as indication of anticoagulation. There were no significant differences
in all-cause mortality, major and/or life-threatening bleeding, and stroke in patients
treated with DOACs versus VKA (odds ratio [OR] 1.07, 95% confidence interval [CI]
[0.73 to 1.57], p = 0.72, OR = 0.85, 95% CI [0.64 to 1.12], p = 0.24, OR 1.52, 95%
CI [0.93 to 2.48], p = 0.09, respectively). In conclusion, in patients undergoing
TAVI with concomitant indication for oral anticoagulation, all-cause mortality, major
and/or life-threatening bleeding, and stroke were similar between DOACs and VKA. Further
large scale randomized controlled trials are needed to search the optimal oral anticoagulation
regimen in this population.
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Article info
Publication history
Published online: January 08, 2020
Received in revised form:
December 22,
2019
Received:
October 28,
2019
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
