Non-vitamin K oral anticoagulants (NOACs) are associated with fewer major bleeding events and deaths than vitamin K antagonists (VKAs) when treating patients who develop new-onset atrial fibrillation (AFib) after transcatheter aortic valve replacement (TAVR), according to a new meta-analysis published in Frontiers in Cardiovascular Medicine.
“AFib events significantly increase the risk of stroke, bleeding and death after TAVR,” wrote Lu Wang, with the cardiac pacing and electrophysiology department at The First Affiliated Hospital of Xinjiang Medical University in China, and colleagues. “Therefore, there is a need for anticoagulant therapy for such patients.”
Wang et al. explained that NOACs have gained momentum in recent years as a go-to anticoagulation option among TAVR patients. However, they said, evidence detailing the superiority of NOACs has remained limited. The authors hoped a meta-analysis could provide more context and help clinicians make treatment decisions when providing care for this patient population.
The group performed a meta-analysis of three randomized controlled trials (RCTs) and 10 observational studies completed through January 2023. This covered a total of 30,388 patients who underwent TAVR and then presented with new-onset AFib.
Overall, NOACs were associated with a significantly lower number of major bleeding events (11.3% vs. 13.9%) and significantly lower all-cause mortality (14.2% vs. 17.6%) than VKAs. There was no statistical difference in the overall stroke rate.
Rivaroxaban was the most commonly used NOAC, the authors added, likely due to its “once-daily dosing schedule” and “better anticoagulant effect.”
Reviewing these findings, the authors determined that the use of NOACs “is an effective and safe anticoagulant strategy” for TAVR patients who go on to develop AFib. They also examined the fact that care teams tend to prefer rivaroxaban.
“It is speculated that this regimen has relatively few side effects on patients, so patients' compliance is better,” the authors wrote. “In addition, it may also be due to clinical experience which indicate that this regimen is more conducive to the prognosis of patients.”
Click here to read the full meta-analysis.