Antithrombotic Treatment After Valve-in-Valve, Valve-in-Ring, and Valve-in-MAC Procedures: A Systematic Review and Meta-Analysis
Why this work is in the frame
A frame that forgets how it found something cannot be audited. These are the routes that admitted this work.
Bibliographic record
Abstract
INTRODUCTION: While antithrombotic therapy following transcatheter valve implantation has been extensively studied in various clinical trials, there remains a notable gap in evidence regarding the optimal approach following valve-in-valve (ViV), valve-in-ring (ViR) and valve-in-mitral annular calcification (ViMAC) procedures, warranting further assessment. This gap is particularly concerning due to the apparent increased risk of thrombosis associated with ViV interventions. The aim of this systematic review was to explore the potential benefits of anticoagulation in ViV, ViR, and ViMAC procedures. METHODS: We searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials, as well as the grey literature, for observational and interventional studies published until December 2023. Trials were included if a comparative analysis between the two antithrombotic strategies was feasible and excluded if patients under 18 years old were analysed. The primary efficacy endpoints were incidence of clinical and total valve thrombosis (VT), major bleeding was the sole safety primary endpoint. Additional analyses were performed regarding valves in the mitral position and valve type. The risk of bias was evaluated using the Newcastle-Ottawa scale. Data was assessed using the Review Manager 5.4 software. RESULTS: A total of five observational and one case series were included (n = 614 on anticoagulation and n = 468 on antiplatelets), comprising a total of 1082 participants. Clinical VT rates were 4.2% for all procedures, and patients on anticoagulants were associated with a a lower risk of clinical VT (1.1% vs 8.3%; OR: 0.18; 95% CI: 0.07 - 0.42, I2: 0%) and total VT (1.3% vs 8.5%; OR: 0.16; 95% CI: 0.07 - 0.37, I2: 0%). Regarding bleeding events, the existing literature did not provide adequate information to enable a thorough analysis. CONCLUSION: Our study suggests a potential benefit of anticoagulation regimens to decrease the high rates of VT following valve-in-valve, valve-in-ring and valve-in-mitral annular calcification procedures. However, the lack of randomized controlled trials and data on bleeding and mortality emphasises the necessity for further research.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.019 | 0.022 |
| Bibliometrics | 0.002 | 0.003 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it