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Anticoagulation following valve-in-valve, valve-in-ring and valve-in-MAC - a systematic review with metaanalysis
Session:
Sessão de Posters 52 - Intervenção na doença valvular
Speaker:
Gonçalo Terleira Batista
Congress:
CPC 2024
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
25. Interventional Cardiology
Subtheme:
25.3 Non-coronary Cardiac Intervention
Session Type:
Cartazes
FP Number:
---
Authors:
Gonçalo Terleira Batista; Gonçalo Ferraz Costa; Tatiana Pereira Dos Santos; Mariana Rodrigues Simões; Ana L Silva; Joana Guimarães; Diogo Fernandes; Bernardo Resende; Eric Monteiro; Rafaela Fernandes; Joana Delgado Silva; Lino Gonçalves
Abstract
<p><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong>Background:</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"> Antithrombotic therapy after transcatheter valve implantation (TVI) is well established. However, antithrombotic management of valve-in-valve (ViV), valve-in-rings (ViR), and valve-in-mitral annular calcification (ViMAC) procedures is controversial.</span></span></span></p> <p> </p> <p><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong>Objective:</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"> To compare anticoagulation regimens after valve-in-valve (ViV), valve-in-ring (ViR), and valve-in-MAC (ViMAC) procedures with no anticoagulation regimens.</span></span></span></p> <p> </p> <p><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong>Methods</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">: We systematically reviewed Pubmed. Embase and Cochrane Central Register of Controlled Trials, and the grey literature for observational and interventional studies published until August 2023, comparing both antithrombotic strategies. Major bleeding and the rate of both clinical and non-clinical valve thrombosis were the primary outcomes. The Newcastle-Ottawa scale and the Cochrane risk of bias tool were employed to evaluate the risk of bias. RevMan 2.0 was incorporated for analyzing the data. The statistical software SPSS (v.28.0.1) was used to conduct secondary analysis.</span></span></span></p> <p> </p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong>Results: </strong></span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">After screening and exclusion of duplicates, we obtained six studies, giving a total of 1,082 participants (614 patients on anticoagulation arms, 468 on no anticoagulation arms). The rate of clinical thrombosis was 5.8% in ViV and ViR procedures and 4.2% for all procedures. The incidence in anticoagulation groups was significantly lower (1.1%) compared to that of the non-anticoagulated groups (9.4%), thus an anticoagulation regiments demonstrated significant effectiveness in reducing clinical valve thrombosis (OR: 0.18; 95% Confidence Intervals [CI]: 0.08-0.45, I2: 0%, p=0.0002) along with total valve thrombosis (OR: 0.16; 95% CI: 0.07-0.37, I2: 0%, p<0.0001). Bleeding and Mortality analysis was not performed due to lack of reporting of events.</span></span></span></p> <p> </p> <p><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong>Conclusions: </strong></span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">In conclusion, our pooled analysis suggests that anticoagulation may be an effective option in reducing the exceedingly high rates of clinical and non-clinical valve thrombosis that take place in patients following ViV, ViR, and ViMAC procedures. </span></span></span></p>
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