Article Impact Level: HIGH Data Quality: STRONG Summary of Clinical Cardiology, 46(6), 598–606. https://doi.org/10.1002/clc.24017 Dr. Jian Zhang et al.
Points
- Transcatheter mitral valve repair (TMVR) using MitraClip is a well-established technique for mitral regurgitation treatment, but anticoagulation protocols lack clear guidelines.
- A meta-analysis was conducted to compare outcomes with and without anticoagulants after TMVR, utilizing data from five observational cohort studies encompassing 1892 TMVR patients.
- The analysis revealed a significantly lower stroke rate in the anticoagulation group (at least four weeks duration) than in the non-anticoagulation group.
- Both groups showed similar bleeding rates, combined endpoints, and all-cause death.
- Anticoagulant use after TMVR demonstrated a reduced risk of stroke without an increased risk of bleeding, combined endpoints, or all-cause death.
Summary
This research paper presents a meta-analysis investigating the outcomes of transcatheter mitral valve repair (TMVR) using MitraClip (MC) with and without the addition of anticoagulants. TMVR is a well-established interventional technique for treating mitral regurgitation, but there is no consensus on antithrombotic medications. The authors aimed to evaluate the effects of anticoagulation after TMVR by analyzing data from observational cohort studies.
To conduct the analysis, the researchers systematically searched several databases for relevant studies published up to October 6, 2022. They identified five observational cohort studies involving 1892 patients who underwent TMVR. These patients were divided into two groups: those receiving anticoagulants (n = 1209) and those not (n = 683). The primary outcomes assessed were bleeding, stroke, combined endpoints, and all-cause death.
The pooled analysis revealed that the anticoagulated group (with anticoagulants administered for at least four weeks) had a significantly lower stroke rate than the non-anticoagulated group. However, the two groups had similar bleeding rates, combined endpoints, and all-cause deaths. These findings suggest that using anticoagulants after TMVR can reduce the risk of stroke without increasing the risk of bleeding, combined endpoints, or all-cause death.
Overall, this meta-analysis provides evidence supporting the benefit of anticoagulation therapy (of at least four weeks duration) following TMVR for mitral regurgitation. By analyzing data from observational studies, the authors demonstrate a lower stroke rate associated with anticoagulants while maintaining comparable outcomes regarding bleeding, combined endpoints, and all-cause death. These findings contribute to understanding antithrombotic protocols in the context of TMVR and can help guide clinical decision-making in this field.
Link to the article: https://onlinelibrary.wiley.com/doi/10.1002/clc.24017
References Zhang, J., Yang, Y., Jia, L., Su, J., Xiao, A., & Lin, X. (2023). Anticoagulation therapy and clinical outcomes following transcatheter mitral valve repair for patients with mitral regurgitation: A meta‐analysis. Clinical Cardiology, 46(6), 598–606. https://doi.org/10.1002/clc.24017
