Continued Versus Interrupted Oral Anticoagulation During Transcatheter Aortic Valve Replacement in Patients With Atrial Fibrillation: A Meta-Analysis

Introduction: A substantial number of patients undergoing transcatheter aortic valve replacement (TAVR) require long-term oral anticoagulants (OAC) owing to comorbidities. This study examined whether continuing oral anticoagulation periprocedurally during TAVR is as safe and effective as interrupting it. Methods: A systematic search of the major databases was performed to identify relevant studies. Effect estimates were calculated using risk ratios (RR) and 95% CIs by pooling the data using the inverse-variance random effects model. Statistical significance was set at P < 0.05. Results: Four studies were included, with 2962 patients undergoing TAVR with continued OAC (n = 1318) and interrupted OAC (n = 1644). The pooled analysis demonstrated that TAVR with continued OAC had comparable risks for all-cause mortality (RR: 0.91; 95% CI, 0.62–1.34; P = 0.64), cardiovascular mortality (RR: 0.89; 95% CI, 0.43–1.84; P = 0.76), stroke (RR: 0.67; 95% CI, 0.42–1.08; P = 0.09), closure device failure (RR: 0.86; 95% CI, 0.47–1.59; P = 0.64), major/life-threatening bleeding (RR: 0.93; 95% CI, 0.74–1.15; P = 0.49), and major vascular complications (RR: 0.97; 95% CI, 0.79–1.20; P = 0.80) compared with TAVR with interrupted OAC. Conclusions: In patients undergoing TAVR, continued OAC showed comparable safety and efficacy with interrupted OAC. These findings demonstrate that continuing OAC in the periprocedural period may be a viable option in patients with atrial fibrillation because of comorbidities requiring anticoagulants.