Comparison of efficacy and safety between VKAs and DOACs in patients with atrial fibrillation after transcatheter aortic valve replacement: A systematic review and meta-analysis.
Comparison of efficacy and safety between VKAs and DOACs in patients with atrial fibrillation after transcatheter aortic valve replacement: A systematic review and meta-analysis.
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DOI：
10.1002/clc.23909
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发表时间：
2022-10
影响因子：
2.7
通讯作者：
An, Fengshaung
中科院分区：
文献类型：
--
作者：
Yan, Jie;Liu, Ming;Zhang, Yu;Yang, Danning;An, Fengshaung
在过去的十年中，直接口服抗凝剂（DOAC）已被证明是非瓣膜性房颤患者的最佳选择。然而，在瓣膜性房颤中使用DOAC进行抗凝治疗的证据仍然不足，特别是在主动脉瓣置换术后。因此，我们进行了一项Meta分析，以比较维生素K拮抗剂（VKA）和DOAC在经导管主动脉瓣置换术（TAVR）后房颤患者中的疗效和安全性。我们对在线数据库进行了全面检索，最终分析纳入了11项研究。主要终点为全因死亡率。次要终点包括卒中和心血管死亡。安全终点是严重和/或危及生命的出血。根据每项研究的不同随访时间进行亚组分析。所有结局均采用随机效应模型。统计学异质性采用χ 2检验进行评估，并采用I2统计量进行量化。DOAC组患者的全因死亡风险显著低于VKA组患者（相对风险[RR]：1.20，95%置信区间[CI]：1.01-1.43，p = 0.04）。随着随访时间的延长，这种获益可能会更大。在基于随访时间的亚组分析中，在随访时间>12个月的亚组中，DOAC组的全因死亡风险显著较低（RR：1.50，95% CI：1.07-2.09，p = .001）。两组在心血管死亡、卒中和严重和/或危及生命的出血方面无显著差异。对于TAVR后的房颤患者，DOAC的使用可能上级VKA，随访时间越长，获益可能越大。TAVR术后房颤的抗凝策略是未来研究的一个有价值的方向。
In the past decade, direct oral anticoagulants (DOACs) have proven to be the best option for patients with nonvalvular atrial fibrillation. Nevertheless, evidence for the use of DOACs for anticoagulation in valvular atrial fibrillation, particularly after aortic valve replacement, remains inadequate. Thus, we conducted a meta‐analysis to compare the efficacy and safety of vitamin K antagonists (VKAs) and DOACs in patients with atrial fibrillation after transcatheter aortic valve replacement (TAVR). We conducted a comprehensive search of online databases, and 11 studies were included in the final analysis. The primary endpoint was all‐cause mortality. Secondary endpoints included stroke and cardiovascular death. The safe endpoint is major and/or life‐threatening bleeding. Subgroup analysis was conducted according to the different follow‐up time of each study. Random‐effects models were used for all outcomes. Statistical heterogeneity was assessed using χ 2 tests and quantified using I 2 statistics. Patients in the DOACs group had a significantly lower risk of all‐cause mortality compared with patients in the VKAs group (relative risk [RR]: 1.20, 95% confidence interval [CI]: 1.01–1.43, p = .04). This benefit may be greater with longer follow‐up. In a subgroup analysis based on the length of follow‐up, a significantly lower risk of all‐cause mortality was found in the DOACs group in the subgroup with a follow‐up time of >12 months (RR: 1.50, 95% CI: 1.07–2.09, p = .001). There were no significant differences between the two groups in cardiovascular death, stroke, and major and/or life‐threatening bleeding. For patients with atrial fibrillation after TAVR, the use of DOACs may be superior to VKAs, and the benefit may be greater with longer follow‐up. The anticoagulant strategy for atrial fibrillation after TAVR is a valuable direction for future research.
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