Comparative efficacy and safety of antithrombotic therapy for transcatheter aortic valve replacement: a systematic review and network meta-analysis
Comparative efficacy and safety of antithrombotic therapy for transcatheter aortic valve replacement: a systematic review and network meta-analysis
复制标题
DOI：
--
复制
发表时间：
2019
期刊：
影响因子：
--
通讯作者：
Qingchun Zeng
中科院分区：
文献类型：
--
作者：
Yuexin Zhu;Ziyuan Zou;Yusi Huang;Lei Zhang;Huiting Chen;Yang Li;Cheng Liu;Xinrui Li;Dingli Xu;Qingchun Zeng
OBJECTIVES: We sought to determine the optimal antithrombotic therapy after transcatheter aortic valve replacement..METHODS: Related scientific databases were searched until December 2018. We conducted a pairwise and a network meta-analysis with-.in a frequentist framework, measuring 30-day bleeding, stroke and all-cause mortality. The surface under the cumulative ranking (SUCRA).curve was estimated to rank the therapies. The Grading of Recommendations Assessment, Development and Evaluation (GRADE).approach was performed. The protocol was registered with PROSPERO (CRD42018111163)..RESULTS: Eight studies comprising 2173 patients were analysed. The risk of 30-day bleeding was higher for dual antiplatelet therapy.(DAPT) than single antiplatelet therapy (SAPT) [odds ratio (OR) 1.90 (1.10–3.28); P=0.02], whereas there was no difference in the risk of 30-.day stroke [OR 1.27 (0.38–4.20); P=0.69] and mortality [OR 1.46 (0.67–3.22); P=0.34] between DAPT and SAPT. In the network meta-.analysis, DAPT+oral anticoagulant (OAC) increased the risk of 30-day bleeding compared with SAPT [OR 6.21 (1.74–22.17); P=0.005],.DAPT [OR 3.27 (1.04–10.32); P=0.043], SAPT+OAC [OR 4.87 (2.51–9.45); P<0.001] and OAC [OR 14.4 (1.3–154.7); P=0.028]. Additionally,.patients receiving DAPT + OAC had the highest risks for 30-day bleeding (SUCRA 1.0%). OAC seemed to be superior to SAPT and DAPT in.terms of 30-day bleeding (SUCRA OAC: 86.3%, SAPT: 72.3%, DAPT: 32.3%) and stroke (SUCRA 54.2%, 47.4%, 40.5%), but not mortality.(SUCRA 69.6%, 74.1%, 43.4%)..CONCLUSIONS: There is a trend towards less bleeding with the application of SAPT, but no mortality benefit with the application of DAPT.is shown. The comparison of SAPT, DAPT and OAC shows that OAC may improve the balance between stroke and bleeding, which can re-.duce the risk of mortality. In addition, the application of DAPT+OAC was ranked the worst amongst all treatment modalities and should.be avoided due to an increased risk of bleeding.
