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Background <p>The appropriate periprocedural management of oral anticoagulation in transcatheter aortic valve implantation (TAVI) patients who require long-term anticoagulation remains controversial.</p> Purpose <p>This systematic review and meta-analysis compare the efficacy and safety of periprocedural continuation versus interruption of anticoagulation in patients undergoing TAVI with an indication for long-term anticoagulation.</p> Methods <p>We searched PubMed, Embase, and Cochrane Central databases to identify relevant articles. We included both observational and randomized controlled trials. Data were analysed using random-effects model to calculate the odds ratio (OR) with 95% confidence intervals (CIs). A <i>p</i> &lt; .05 was considered statistically significant.</p> Results <p>Four studies comprising 3,144 patients, with anticoagulation continued in 1,500 (47.7%) patients were included. There were no difference between periprocedural continuation and interruption of anticoagulation in the incidence of composite outcomes (OR: 0.84; 95% CI: 0.64–1.10; <i>p</i> = .19), major bleeding (OR: 0.98; 95% CI: 0.57–1.68; <i>p</i> = .95), major vascular complications (OR: 0.93; 95% CI: 0.72–1.20; <i>p</i> = .60), and myocardial infarction (MI) (OR: 0.60; 95% CI: 0.20–1.77; <i>p</i> = .36). However, the incidence of stroke was significantly lower in the continuation group (OR: 0.61; 95% CI: 0.39–0.94; <i>p</i> = .03). The incidence of blood transfusion was not significantly different between the continuation and interruption groups (OR: 0.86; 95% CI: 0.42–1.77; <i>p</i> = .68).</p> Conclusions <p>In this meta-analysis comparing periprocedural continuation of anticoagulation to interruption of therapy in patients undergoing TAVI with concomitant indications for long-term anticoagulation, continuation of anticoagulation was associated with a lower incidence of stroke without increasing the risk of bleeding. These findings suggest a potentially favourable safety profile in favour of continuation of anticoagulant therapy, they should be interpreted with caution and validated in larger and well-designed randomised trials.</p> <p>The review protocol was prospectively registered with the International Prospective Register of Systematic Reviews (PROSPERO), registration number (CRD42024607149).</p>

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Efficacy and safety of continuation vs. interruption of anticoagulation during transcatheter aortic valve implantation: A systematic review and meta-analysis

  • 期刊论文

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  • 发表日期：

    2025年10月10日

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  • Umar G. Adamu,
  • Marheb Badianyama,
  • Anupa Patel,
  • Arthur Mutyaba,
  • Nqoba Tsabedze

摘要

Background

The appropriate periprocedural management of oral anticoagulation in transcatheter aortic valve implantation (TAVI) patients who require long-term anticoagulation remains controversial.

Purpose

This systematic review and meta-analysis compare the efficacy and safety of periprocedural continuation versus interruption of anticoagulation in patients undergoing TAVI with an indication for long-term anticoagulation.

Methods

We searched PubMed, Embase, and Cochrane Central databases to identify relevant articles. We included both observational and randomized controlled trials. Data were analysed using random-effects model to calculate the odds ratio (OR) with 95% confidence intervals (CIs). A p < .05 was considered statistically significant.

Results

Four studies comprising 3,144 patients, with anticoagulation continued in 1,500 (47.7%) patients were included. There were no difference between periprocedural continuation and interruption of anticoagulation in the incidence of composite outcomes (OR: 0.84; 95% CI: 0.64–1.10; p = .19), major bleeding (OR: 0.98; 95% CI: 0.57–1.68; p = .95), major vascular complications (OR: 0.93; 95% CI: 0.72–1.20; p = .60), and myocardial infarction (MI) (OR: 0.60; 95% CI: 0.20–1.77; p = .36). However, the incidence of stroke was significantly lower in the continuation group (OR: 0.61; 95% CI: 0.39–0.94; p = .03). The incidence of blood transfusion was not significantly different between the continuation and interruption groups (OR: 0.86; 95% CI: 0.42–1.77; p = .68).

Conclusions

In this meta-analysis comparing periprocedural continuation of anticoagulation to interruption of therapy in patients undergoing TAVI with concomitant indications for long-term anticoagulation, continuation of anticoagulation was associated with a lower incidence of stroke without increasing the risk of bleeding. These findings suggest a potentially favourable safety profile in favour of continuation of anticoagulant therapy, they should be interpreted with caution and validated in larger and well-designed randomised trials.

The review protocol was prospectively registered with the International Prospective Register of Systematic Reviews (PROSPERO), registration number (CRD42024607149).