Meta-Analysis
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Mar 26, 2025; 17(3): 104000
Published online Mar 26, 2025. doi: 10.4330/wjc.v17.i3.104000
Outcomes of periprocedural continuation vs interruption of oral anticoagulation in transcatheter aortic valve replacement
Aman Goyal, Aqsa Shoaib, Areeba Fareed, Sara Jawed, Muhammad Taha Khan, Najwa Salim, Ushna Zameer, Amna Siddiqui, Tanya Thakur, Samia Aziz Sulaiman
Aman Goyal, Department of Internal Medicine, Seth GS Medical College and KEM Hospital, Mumbai 400012, Maharashtra, India
Aqsa Shoaib, Areeba Fareed, Sara Jawed, Muhammad Taha Khan, Najwa Salim, Ushna Zameer, Amna Siddiqui, Department of Internal Medicine, Karachi Medical and Dental College, Karachi 74700, Sindh, Pakistan
Tanya Thakur, Department of Internal Medicine, Government Medical College, Patiala 147001, Punjab, India
Samia Aziz Sulaiman, Department of Internal Medicine, The University of Jordan, Amman 11183, Jordan
Co-first authors: Aman Goyal and Aqsa Shoaib.
Author contributions: Goyal A and Sulaiman SA reviewed and edited the final draft; Goyal A, Shoaib A, Fareed A, Jawed S, Khan MT, Salim N, Zameer U, Siddiqui A, Thakur T, and Sulaiman SA wrote the original draft and contributed to data curation and formal analysis; All of the authors read and approved the final version of the manuscript to be published.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Samia Aziz Sulaiman, MD, Department of Internal Medicine, The University of Jordan, Water and Environment Research and Study Center, Amman 11183, Jordan. samia.sulaiman2003@gmail.com
Received: December 6, 2024
Revised: January 27, 2025
Accepted: February 21, 2025
Published online: March 26, 2025
Processing time: 105 Days and 0.7 Hours
Abstract
BACKGROUND

Up to one-third of patients undergoing transcatheter aortic valve replacement (TAVR) have an indication for oral anticoagulation (OAC), primarily due to underlying atrial fibrillation. The optimal approach concerning periprocedural continuation vs interruption of OAC in patients undergoing TAVR remains uncertain, which our meta-analysis aims to address.

AIM

To explore safety and efficacy outcomes for patients undergoing TAVR, comparing periprocedural continuation vs interruption of OAC therapy.

METHODS

A literature search was conducted across major databases to retrieve eligible studies that assessed the safety and effectiveness of TAVR with periprocedural continuous vs interrupted OAC. Data were pooled using a random-effects model with risk ratio (RR) and their 95% confidence interval (CI) as effect measures. All statistical analyses were conducted using Review Manager with statistical significance set at P < 0.05.

RESULTS

Four studies were included, encompassing a total of 1813 patients with a mean age of 80.6 years and 49.8% males. A total of 733 patients underwent OAC interruption and 1080 continued. Stroke incidence was significantly lower in the OAC continuation group (RR = 0.62, 95%CI: 0.40-0.94; P = 0.03). No significant differences in major vascular complications were found between the two groups (RR = 0.95, 95%CI: 0.77-1.16; P = 0.60) and major bleeding (RR = 0.90, 95%CI: 0.72-1.12; P = 0.33). All-cause mortality was non-significant between the two groups (RR = 0.83, 95%CI: 0.57-1.20; P = 0.32).

CONCLUSION

Continuation of OAC significantly reduced stroke risk, whereas it showed trends toward lower bleeding and mortality that were not statistically significant. Further large-scale studies are crucial to determine clinical significance.

Keywords: Transcatheter aortic valve replacement; Oral anticoagulants; Systematic review; Cardiology; Outcomes

Core Tip: Periprocedural continuation of oral anticoagulation (OAC) in transcatheter aortic valve replacement (TAVR) significantly reduces stroke risk (risk ratio = 0.62, P = 0.03) without increasing the incidence of major bleeding or vascular complications. Although no statistically significant difference in all-cause mortality was observed, the results suggest a favorable safety and efficacy profile for OAC continuation. These findings underscore the need for further large-scale, randomized trials to establish definitive guidelines for periprocedural anticoagulation management in patients undergoing TAVR.