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<p>Hypoattenuated leaflet thickening (HALT), a subclinical form of valve thrombosis, is a common finding after transcatheter aortic valve replacement (TAVR). While anticoagulant therapy has been associated with HALT resolution, the efficacy and safety of this approach remain uncertain. To evaluate the effectiveness and safety of oral anticoagulant (OAC) therapy in resolving HALT after TAVR. A systematic review and meta-analysis was performed in accordance with PRISMA guidelines and registered in PROSPERO (CRD420251045514). Studies including adult TAVR patients with imaging-confirmed HALT treated with anticoagulants were included. Outcomes assessed included HALT resolution, valve dysfunction, and major bleeding. Risk of bias was assessed using the ROBINS-I tool, and certainty of evidence was evaluated via GRADE. Summary estimates were calculated using a random-effects model. Nine observational studies involving 369 patients were included, with a follow-up ranging from 78 to 217.6 days, and ranging from 5 days to 9.6 months of interval between TAVR and imaging. The overall pooled HALT resolution rate in imaging follow-up was 90% (95% CI: 0.84–0.95; I² = 15.0%). Otherwise, when discontinuation of OAC had a recurrence rate of 69% (95% CI: 0.49–0.84, I²=0). The bleeding event proportion was 0.05 (95% CI: 0.01–0.18, I² = 0.0%). Sensitivity analyses excluding influential studies suggest the robustness of findings. Anticoagulant therapy is associated with high rates of HALT resolution and appears superior to antiplatelet therapy. These findings support the role of anticoagulation in selected post-TAVR patients with HALT, though randomized trials are needed to confirm efficacy and assess bleeding risk.</p> Graphical Abstract <p></p>

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Efficacy and safety of anticoagulant therapy for hypoattenuated leaflet thickening Post-TAVR: A systematic review and meta-analysis

  • 期刊论文

  • 发表日期：

    2025年12月28日

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  • Gabriel Caruso Novaes Tudella,
  • Camila Sales Fagundes,
  • Taíne De Conto,
  • Mateus Diniz Marques,
  • Diego Chemello

摘要

Hypoattenuated leaflet thickening (HALT), a subclinical form of valve thrombosis, is a common finding after transcatheter aortic valve replacement (TAVR). While anticoagulant therapy has been associated with HALT resolution, the efficacy and safety of this approach remain uncertain. To evaluate the effectiveness and safety of oral anticoagulant (OAC) therapy in resolving HALT after TAVR. A systematic review and meta-analysis was performed in accordance with PRISMA guidelines and registered in PROSPERO (CRD420251045514). Studies including adult TAVR patients with imaging-confirmed HALT treated with anticoagulants were included. Outcomes assessed included HALT resolution, valve dysfunction, and major bleeding. Risk of bias was assessed using the ROBINS-I tool, and certainty of evidence was evaluated via GRADE. Summary estimates were calculated using a random-effects model. Nine observational studies involving 369 patients were included, with a follow-up ranging from 78 to 217.6 days, and ranging from 5 days to 9.6 months of interval between TAVR and imaging. The overall pooled HALT resolution rate in imaging follow-up was 90% (95% CI: 0.84–0.95; I² = 15.0%). Otherwise, when discontinuation of OAC had a recurrence rate of 69% (95% CI: 0.49–0.84, I²=0). The bleeding event proportion was 0.05 (95% CI: 0.01–0.18, I² = 0.0%). Sensitivity analyses excluding influential studies suggest the robustness of findings. Anticoagulant therapy is associated with high rates of HALT resolution and appears superior to antiplatelet therapy. These findings support the role of anticoagulation in selected post-TAVR patients with HALT, though randomized trials are needed to confirm efficacy and assess bleeding risk.

Graphical Abstract