# Antithrombotic strategies after transcatheter aortic valve replacement a network meta-analysis

## TL;DR

This study compares different antithrombotic treatments after heart valve replacement and finds single antiplatelet therapy is safer for patients not needing blood thinners.

## Contribution

The study provides new evidence that single antiplatelet therapy reduces major bleeding risks compared to direct oral anticoagulants after TAVR.

## Key findings

- Single antiplatelet therapy (SAPT) had lower major/life-threatening bleeding than direct oral anticoagulants (OR: 0.68, 95% CI: 0.47–0.99).
- No significant differences were observed in other safety or efficacy endpoints between treatment groups.

## Abstract

The optimal antithrombotic regimen for patients without an indication for oral anticoagulation (OAC) after transcatheter aortic valve replacement (TAVR) remains unclear. We conducted a network meta-analysis of randomized controlled trials to clarify the best postoperative antithrombotic regimen. We searched literature databases including PubMed/Medline and Cochrane up to June 2024. Safety endpoints included all-cause death, cardiovascular death, major/life-threatening bleeding, and minor bleeding during follow-up. Efficacy endpoints encompassed ischaemic stroke transient ischemic attack (TIA), systemic embolism, hypoattenuated leaflet thickening (HALT), and reduced leaflet motion (RELM). Outcomes were assessed during the follow-up period specified in each trial (range:3–24 months). The results were statistically analyzed using R 4.3.2 and Stata 16 software. The final analysis included seven randomized controlled trials. Single antiplatelet therapy (SAPT) showed a lower incidence of major/life-threatening bleeding compared to the direct oral anticoagulants (DOACs) group (OR: 0.68, 95% CI: 0.47–0.99, P = 0.002) during the 3–24 month post-TAVR period. However, no significant differences were found in other safety or efficacy endpoints. SAPT is the preferred treatment strategy for TAVR patients without anticoagulation indications.

identifier, PROSPERO registration number: CRD42024584735.