Efficacy and safety of different antithrombotic treatment regimens in patients undergoing transcatheter mitral valve repair and atrial fibrillation; A meta-analysis and systematic review
Abstract
Background: Optimal antithrombotic therapy following transcatheter mitral valve repair (TMVR/TEER) in patients with atrial fibrillation remains uncertain, with substantial practice variation and reliance on nonrandomized data.
Methods: We performed a systematic review and network meta-analysis of observational studies evaluating antithrombotic strategies after TMVR/TEER with atrial fibrillation. Antithrombotic regimens were harmonized into two main categories: oral anticoagulation [OAC; including vitamin K antagonists [VKAs] and direct oral anticoagulants [DOACs]] and antiplatelet therapy (APT; including aspirin or clopidogrel, alone or in combination). Outcomes of interest were ischemic stroke, major bleeding, and all-cause mortality. Pairwise and network random-effects models were applied to derive odds ratios (ORs) with 95% confidence intervals (CIs).
Results: Four multicenter observational cohorts (n = 2,098) were included. Across comparisons, OAC strategies demonstrated a favorable profile compared with APT for bleeding risk reduction, while DOACs showed heterogeneous results depending on comparator drug and study region (phenprocoumon in Europe vs. warfarin in the U.S.). Mortality findings consistently favored OAC (particularly DOACs) potential benefits over APT. For stroke, OAC (phenprocoumon) showed better ischemic prevention, indicating more effectiveness in minimizing stroke risk compared with APT. Network geometry was limited, with most contrasts informed by only…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 2,098 participants or records.
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