NOACs vs. VKAs in TAVR patients with new-onset AFib: New meta-analysis examines key differences

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.[1]

“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.