PMID- 36431258
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20221213
IS  - 2077-0383 (Print)
IS  - 2077-0383 (Electronic)
IS  - 2077-0383 (Linking)
VI  - 11
IP  - 22
DP  - 2022 Nov 16
TI  - The Efficacy and Safety of Direct Oral Anticoagulants versus Standard of Care in 
      Patients without an Indication of Anti-Coagulants after Transcatheter Aortic 
      Valve Replacement: A Meta-Analysis of Randomized Controlled Trials.
LID - 10.3390/jcm11226781 [doi]
LID - 6781
AB  - Transcatheter aortic valve replacement (TAVR) is now considered the mainstay of 
      aortic stenosis management; however, the optimal antithrombotic therapy in patent 
      without indications for an oral anticoagulant (OAC) is yet to be identified. 
      Therefore, we conducted a systematic review and meta-analysis to evaluate the 
      efficacy and safety of direct oral anticoagulant (DOAC) treatment versus the 
      standard of care in patients without indications of OACs after TAVR. We 
      synthesized randomized controlled trials (RCTs) from Web of Science, SCOPUS, 
      EMBASE, PubMed, and Cochrane until 18 August 2022. We used the risk ratio (RR) 
      for dichotomous outcomes with the corresponding 95% confidence interval (CI). We 
      registered our protocol in PROSPERO with ID: CRD42022357027. Three RCTs with 2922 
      patients were identified. DOACs were significantly associated with higher 
      incidence of all-cause mortality (RR: 1.68 with 95% CI [1.22, 2.30], p = 0.001), 
      mortality due to non-cardiovascular causes (RR: 2.34 with 95% CI [1.36, 4.02], p 
      = 0.002), and the composite outcome of death, myocardial infarction, or stroke 
      (RR: 1.41 with 95% CI [1.13, 1.76], p = 0.002). However, DOACs were associated 
      with decreased incidence of reduced leaflet motion (RLM) (RR: 0.19 with 95% CI 
      [0.09, 0.41], p = 0.0001) and hypoattenuated leaflet thickening (HALT) (RR: 0.50 
      with 95% CI [0.36, 0.70], p = 0.0001). DOACs were effective to reduce RLM and 
      HALT; however, the clinical effect of this is still controversial. DOACs were 
      associated with worse efficacy and safety outcomes, including all-cause 
      mortality. Further RCTs investigating the optimal antithrombotic regimen after 
      TAVR.
FAU - Abuelazm, Mohamed
AU  - Abuelazm M
AUID- ORCID: 0000-0002-2514-0689
AD  - Faculty of Medicine, Tanta University, Tanta 31527, Egypt.
FAU - Abdelazeem, Basel
AU  - Abdelazeem B
AUID- ORCID: 0000-0002-2919-6196
AD  - Department of Internal Medicine, McLaren Health Care, Flint, MI 48532, USA.
AD  - Department of Internal Medicine, Michigan State University, East Lansing, MI 
      48823, USA.
FAU - Katamesh, Basant E
AU  - Katamesh BE
AUID- ORCID: 0000-0001-9992-2387
AD  - Faculty of Medicine, Tanta University, Tanta 31527, Egypt.
FAU - Gamal, Mohamed
AU  - Gamal M
AUID- ORCID: 0000-0001-5302-5349
AD  - Faculty of Medicine, Tanta University, Tanta 31527, Egypt.
FAU - Simhachalam Kutikuppala, Lakshmi Venkata
AU  - Simhachalam Kutikuppala LV
AUID- ORCID: 0000-0002-5685-6049
AD  - Faculty of Modern Medicine, Dr. N.T.R. University of Health Sciences, Vijayawada 
      520008, Andhra Pradesh, India.
FAU - Kheiri, Babikir
AU  - Kheiri B
AD  - Electrophysiology and Arrhythmias Service, Division of Cardiology, Department of 
      Medicine, University of California, San Francisco, CA 94117, USA.
FAU - Brasic, James Robert
AU  - Brasic JR
AUID- ORCID: 0000-0002-3948-4853
AD  - Section of High-Resolution Brain Positron Emission Tomography Imaging, Division 
      of Nuclear Medicine and Molecular Imaging, The Russell H. Morgan Department of 
      Radiology and Radiological Science, The Johns Hopkins University School of 
      Medicine, Baltimore, MD 21287, USA.
FAU - Paul, Timir K
AU  - Paul TK
AD  - Department of Clinical Medical Education, The University of Tennessee Health 
      Sciences Center at Nashville, Nashville, TN 38163, USA.
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20221116
PL  - Switzerland
TA  - J Clin Med
JT  - Journal of clinical medicine
JID - 101606588
PMC - PMC9698271
OTO - NOTNLM
OT  - aortic stenosis
OT  - apixaban
OT  - atrial fibrillation
OT  - cerebral hemorrhage
OT  - confidence interval
OT  - edoxaban
OT  - flow chart
OT  - rivaroxaban
OT  - thrombosis
OT  - valvular heart diseases
COIS- The authors declare no conflict of interest.
EDAT- 2022/11/27 06:00
MHDA- 2022/11/27 06:01
PMCR- 2022/11/16
CRDT- 2022/11/26 01:22
PHST- 2022/10/12 00:00 [received]
PHST- 2022/11/14 00:00 [revised]
PHST- 2022/11/15 00:00 [accepted]
PHST- 2022/11/26 01:22 [entrez]
PHST- 2022/11/27 06:00 [pubmed]
PHST- 2022/11/27 06:01 [medline]
PHST- 2022/11/16 00:00 [pmc-release]
AID - jcm11226781 [pii]
AID - jcm-11-06781 [pii]
AID - 10.3390/jcm11226781 [doi]
PST - epublish
SO  - J Clin Med. 2022 Nov 16;11(22):6781. doi: 10.3390/jcm11226781.