Novel Oral Anticoagulants Versus Vitamin K Antagonists in Atrial Fibrillation

In a meta-analysis, published in Catheterization and Cardiovascular Interventions, researchers concluded outcomes with novel oral anticoagulants (NOACs) were not significantly different than outcomes with guideline-recommended vitamin K antagonists (VKAs) in patients with atrial fibrillation undergoing transcatheter aortic valve replacement (TAVR).

The research team, led by Muhammad Mustafa Memon, retrieved 12 studies comparing NOACs and VKAs from the Medline, Scopus, and Cochrane central databases. Subgroup and meta-regression analysis were performed on the total cohort of 12,203 patients (mean age 81.2 years; 50.5% male).

According to the article, the authors’ pooled analysis found no significant differences between NOACs and VKAs for stroke or systemic embolism (risk ratio [RR]: 0.78; p=0.18), major bleeding (RR: 0.69; p=0.07), intracranial hemorrhage (RR: 0.61; p=0.06), all-cause mortality (RR: 0.69), and myocardial infection (RR: 1.60; p=0.24) at a mean follow-up of 15.1 months. Outcomes of subgroups were also comparable between the included randomized controlled trials (n = 3), and observational trails (n = 9). After meta-regression analysis, the authors found that heterogeneity in the reported all-cause mortality outcomes were explained by percentage of males, mean age, and CHA2DS2-VASc score.

Ultimately, the authors judged that NOACs did not significantly differ from guideline-recommended VKAs in patients with atrial fibrillation who underwent TAVR.