Scientific Poster Session II: Systematic Reviews/Meta-Analysis

Systematic Reviews/Meta-Analysis
  Sunday, November 12, 2023
  12:45 PM–02:15 PM

Abstract

Background: The optimal regimen of antithrombotic therapy in adult patients who undergo transcatheter aortic valve implantation (TAVI) is unknown. We performed a systematic review/network meta-analysis to compare different anticoagulant/antiplatelet regimens. The primary outcome was all-cause death. Secondary outcomes were major adverse cardiovascular events (MACE) and major bleeding.

Methods: We searched MEDLINE, Embase, and CENTRAL from inception to April 2023. Included were randomized controlled trials that compared single antiplatelet therapy (SAPT), dual antiplatelet therapy (DAPT), or oral anticoagulant (OAC) therapy with/without SAPT, and reported one or more outcomes of interest. No language restrictions were applied. Quality assessments were performed using the Cochrane risk-of-bias tool 2. Bayesian network meta-analyses were performed to compare all interventions simultaneously using the Markov-chain Monte Carlo method with median ranking. Odds ratios (OR) with 95% credible intervals (CrI) were generated using a hierarchical Bayesian framework and random-effects model with informative priors.

Results: From 262 citations, 11 RCTs (N=6415) were included. Median age was 81 years. Median follow-up was 6 months. Compared to DAPT, DOAC+SAPT had a higher risk of all-cause death (OR 1.77, 95% CrI 1.15-2.75) with no difference between DAPT and SAPT (OR 0.99, 95% CrI 0.58-1.66). DOAC+SAPT increased the risk of major bleeding compared to DAPT (OR 2.18, 95% CrI 1.09-4.54), while SAPT lowered the risk (OR 0.41, 95% CrI 0.19-0.84). There was no difference in MACE between DAPT and other regimens. SAPT ranked best for all-cause death, MACE, and major bleeding.

Discussion: In post-TAVI patients, SAPT may provide the optimal balance of reducing thrombotic events while minimizing risk of bleeding. Overall risk of bias was low or with some concerns. This network meta-analysis used widely-accepted methodology and standardized outcome definitions. There remains a need for an adequately-powered trial to compare SAPT and DAPT.

Other: This study was unfunded. The authors disclose no conflicts of interest. PROSPERO registration number CRD42021251819.

Presenting Author

Arden Barry BSc, BSc(Pharm), PharmD, ACPR
University of British Columbia

Authors

Ursula Ellis MLIS
The University of British Columbia

Ricky Turgeon BSc(Pharm), ACPR, PharmD
University of British Columbia