Comparative Efficacy of Antithrombotic Strategies in Bioprosthetic Aortic Valve Replacement: A Network Meta-Analysis

This meta-analysis evaluates outcomes in patients undergoing bioprosthetic aortic valve replacement (bAVR), comparing different antithrombotic strategies. We conducted a systematic search through May 2024. A standard meta-analysis compared outcomes between patients who received anticoagulation therapy (AC) and those who did not. Therapeutic categories were subdivided into four groups: AC alone, AC with antiplatelet therapy (AP), AP alone, and no antithrombotic therapy. A network meta-analysis was performed for these categories. The review included 16 studies, comprising a total of 59,054 patients. There was no significant difference in all-cause mortality rates (HR: hazard ratio [95% CI: confidence interval] = 0.98 [0.77-1.25], <i>P</i> = .88) or thromboembolic events (HR [95% CI] = 0.91 [0.65-1.28], <i>P</i> = .60) between patients with and without AC. However, bleeding events were significantly higher in patients receiving AC (HR [95% CI] = 1.55 [1.20-2.00], <i>P</i> < .01). Network meta-analysis showed that AP alone was associated with lower mortality rates compared with other therapeutic categories. Additionally, AP alone was associated with fewer bleeding events compared with AC alone and AC with AP. This meta-analysis suggests that AP alone in patients undergoing bAVR is associated with superior outcomes compared with other antithrombotic strategies.