Antithrombotic therapy comparison among the included studies.
| Study | Antithrombotic therapy | Antithrombotic regimen | Dosage | Duration of therapy | Comparator & impact on outcomes (bleeding, stroke, mortality) |
|---|---|---|---|---|---|
| El Bèze et al. [15] | DOACs vs. VKAs | DOACs (apixaban, rivaroxaban, dabigatran) | ≥ 3 months, stopped after imaging | Post-TMVR | DOACs are associated with a 79% reduction in bleeding risk (9% vs. 40% with VKAs) and similar stroke/mortality outcomes. |
| Guerrero et al. [16] | VKAs, DOACs, antiplatelet therapy | VKAs (INR 2–3), DOACs, antiplatelet | Long-term therapy | - | Higher bleeding risk with VKAs, no significant difference in stroke/mortality. DOACs are safer with lower bleeding risk. |
| Giustino et al. [17] | DAPT (aspirin + clopidogrel) | Aspirin: 75–100 mg/day, clopidogrel: 75 mg/day | 6 months (aspirin), 1 month (clopidogrel) | Post-TEER | Higher bleeding rate with DAPT vs. SAPT, no added thromboembolic benefit. |
| Körber et al. [18] | SAPT, DAPT, VKAs, DOACs, combined therapy | SAPT (aspirin), DAPT, VKAs, DOACs | SAPT: 75–100 mg/day | Long-term | DAPT is associated with a higher bleeding risk (HR: 3.52) and no additional stroke prevention benefit. |
| Paukovitsch et al. [19] | Triple therapy (OAC + DAPT) | OAC + DAPT | Not specified | Post-TEER | Triple therapy increased bleeding risk (24%), with no additional thromboembolic protection or mortality benefit. |
| Nathan et al. [20] | VKAs, DOACs, no therapy | VKAs (INR 2–3), DOACs | Long-term | - | DOACs are associated with lower bleeding risk, similar stroke prevention, and reduced mortality compared to VKAs. |
| Li et al. [21] | VKA (warfarin) | Warfarin (INR 2.5) | 3–6 months | Post-valve-in-valve-TMVR | Stroke: 6.1%, mortality: 6.1%. No major bleeding data was reported. |
| Geis et al. [22] | DAPT (aspirin + clopidogrel) | Aspirin + clopidogrel | 3–6 months | Post-TEER | Reduced ventricular arrhythmias, with no significant impact on stroke or bleeding. |
| Malaisrie et al. [23] | Warfarin + DAPT | Warfarin (INR ≥ 2) + aspirin/clopidogrel | 6 months | Post-mitral valve-in-valve | 6% valve thrombosis resolved with anticoagulation, and no stroke or mortality was reported. |
| Mentias et al. [14] | DOACs vs. warfarin | DOACs (apixaban, rivaroxaban, dabigatran) | Standard dosing | Continuous | DOACs are associated with lower mortality (HR: 0.67) and major bleeding (HR: 0.79) compared to warfarin. |
| Ludwig et al. [24] | VKA (warfarin) | Warfarin (INR 2.5–3.5) | Lifelong | Post-TMVR | Major bleeding: 18.2%, no strokes reported. |
| Hohmann et al. [25] | NOACs, VKAs, SAPT, DAPT, triple therapy | NOACs, VKAs, SAPT, DAPT | Variable | Continuous (OAC), ≤ 6 months (SAPT/DAPT) | Higher mortality in SAPT/DAPT patients (HR: 3.84) and NOACs are associated with lower bleeding risk. |
| Tichelbäcker et al. [26] | DOACs, VKAs, SAPT, DAPT | DOACs, VKAs, SAPT, DAPT | Variable | Continuous (OAC), 1–6 months (SAPT/DAPT) | Left ventricular thrombus: 1.1% overall, 4.4% in LVEF < 30%. Thrombus cases despite DOAC therapy. VKAs are associated with higher bleeding risk. |
| Schipper et al. [27] | DOAC vs. VKA | DOAC, VKA | Variable | Continued through follow-up | Bleeding, no significant difference in major bleeding rates between DOAC and VKA groups; stroke, similar rates in both groups; Mortality, higher long-term mortality in the VKA group. |
| Alaour et al. [28] | DOAC vs. VKA | DOAC, VKA | Variable | Assessed at 30 days, 1 year, and 5 years post-transcatheter aortic valve replacement | Bleeding rates of life-threatening or major bleeding were similar with DOACs and VKAs through 5 year follow-up. Stroke, long-term incidence of disabling stroke was lower with VKA (HR 0.64, 95% confidence interval 0.46–0.90 for VKA vs. DOAC). Mortality, all-cause mortality was higher with VKA (VKA vs. DOAC HR 1.28 at 1 year and 1.25 at 5 years). Net clinical composite did not differ between therapies at 30 days, 1 year, or 5 years. |
HRs and outcomes are as reported in the individual primary studies; no pooled meta-analysis was performed. -: no data. DAPT: dual antiplatelet therapy; DOACs: direct oral anticoagulants; HR: hazard ratio; INR: international normalized ratio; LVEF: left ventricular ejection fraction; NOAC: non-vitamin-K antagonist oral anticoagulants; OAC: oral anticoagulant; SAPT: single antiplatelet therapy; TEER: transcatheter edge-to-edge repair; TMVR: transcatheter mitral valve repair; VKAs: vitamin K antagonists.