Continued Versus Interrupted Oral Anticoagulation During Transcatheter Aortic Valve Replacement in Patients With Atrial Fibrillation: A Meta-Analysis.

INTRODUCTION

A substantial number of patients undergoing transcatheter aortic valve replacement (TAVR) require long-term oral anticoagulants (OAC) owing to comorbidities. This study examined whether continuing oral anticoagulation periprocedurally during TAVR is as safe and effective as interrupting it.

METHODS

A systematic search of the major databases was performed to identify relevant studies. Effect estimates were calculated using risk ratios (RR) and 95% CIs by pooling the data using the inverse-variance random effects model. Statistical significance was set at P < 0.05.

RESULTS

Four studies were included, with 2962 patients undergoing TAVR with continued OAC (n = 1318) and interrupted OAC (n = 1644). The pooled analysis demonstrated that TAVR with continued OAC had comparable risks for all-cause mortality (RR: 0.91; 95% CI, 0.62-1.34; P = 0.64), cardiovascular mortality (RR: 0.89; 95% CI, 0.43-1.84; P = 0.76), stroke (RR: 0.67; 95% CI, 0.42-1.08; P = 0.09), closure device failure (RR: 0.86; 95% CI, 0.47-1.59; P = 0.64), major/life-threatening bleeding (RR: 0.93; 95% CI, 0.74-1.15; P = 0.49), and major vascular complications (RR: 0.97; 95% CI, 0.79-1.20; P = 0.80) compared with TAVR with interrupted OAC.

CONCLUSIONS

In patients undergoing TAVR, continued OAC showed comparable safety and efficacy with interrupted OAC. These findings demonstrate that continuing OAC in the periprocedural period may be a viable option in patients with atrial fibrillation because of comorbidities requiring anticoagulants.