Optimizing antithrombotic therapy following mitral valve repair: a comprehensive network meta-analysis

Gbreel et al., 2025 | BMC Cardiovasc Disord | Systematic Review

Citation

Gbreel Mohamed Ibrahim, Elkasaby Mohamed Hamouda, ... Balata Mahmoud. Optimizing antithrombotic therapy following mitral valve repair: a comprehensive network meta-analysis. BMC Cardiovasc Disord. 2025-Aug-23;25(1):628. doi:10.1186/s12872-025-04974-4

Abstract

BACKGROUND: Mitral regurgitation (MR) presents either as primary or secondary, with options for surgical or transcatheter repair. Thromboembolic risks following surgery are significant despite the use of antithrombotic medications, and guidelines for postoperative anticoagulation therapy lack consistency. This systematic review aims to compare antithrombotic medications after mitral valve repair (MVR). In this study, we intend to compare antithrombotic medications after MVR. MATERIALS AND METHODS: The study followed the Cochrane handbook and PRISMA guidelines. We systematically searched databases (PubMed, Scopus, Ovid, Cochrane, Web of Science) until June 2024 for TMVR studies using specific criteria. Quality assessment utilized the Newcastle-Ottawa scale. Data extraction encompassed study characteristics and outcomes. Primary outcomes included thromboembolic events and bleeding within six months. Statistical analysis employed R software to assess heterogeneity and publication bias. RESULTS: From the 121 articles screened, 12 were included in the study. These cohort studies, involving 20,644 participants, spanned from 2008 to 2022. While most studies were of good to high quality, some exhibited lower quality. Analysis favored oral anticoagulants (OAC) over single antiplatelet therapy (SAPT) for reducing bleeding risk (RR = 0.31, 95% CI: [0.11-0.87], P < 0.05), with moderate heterogeneity. Thromboembolic events did not significantly differ among interventions. Transient ischemic attacks and stroke outcomes were similar between SAPT and vitamin K antagonists (VKA). Six-month mortality rates were comparable between SAPT and VKA, with notable heterogeneity and higher mortality with SAPT in one study. Qualitative synthesis highlighted procedural success rates and bleeding complications across different interventions in transcatheter mitral valve repair studies. CONCLUSION: OACs showed a lower risk of bleeding compared to antiplatelet therapies, while VKAs and OAC + SAPT may reduce thromboembolic events. No significant differences were found in stroke, TIA, or short-term mortality. These findings support individualized therapy and highlight the need for further randomized trials.

Key Findings

From the 121 articles screened, 12 were included in the study. These cohort studies, involving 20,644 participants, spanned from 2008 to 2022. While most studies were of good to high quality, some exhibited lower quality. Analysis favored oral anticoagulants (OAC) over single antiplatelet therapy (SAPT) for reducing bleeding risk (RR = 0.31, 95% CI: [0.11-0.87], P < 0.05), with moderate heterogeneity. Thromboembolic events did not significantly differ among interventions. Transient ischemic atta

Outcomes Measured

Requires manual extraction

Population

Field	Value
Population	See abstract
Sample Size	20644
Age Range	See abstract
Condition	See abstract

MeSH Terms

Humans
Mitral Valve Insufficiency
Thromboembolism
Risk Assessment
Risk Factors
Treatment Outcome
Mitral Valve
Fibrinolytic Agents
Anticoagulants
Platelet Aggregation Inhibitors
Heart Valve Prosthesis Implantation
Female
Time Factors
Male
Hemorrhage
Aged
Middle Aged
Mitral Valve Annuloplasty

Evidence Classification

Level: Systematic Review
Publication Types: Journal Article, Systematic Review, Network Meta-Analysis
Vertical: vitamin-k

Provenance

PMID: 40849614
DOI: 10.1186/s12872-025-04974-4
PMCID: PMC12374401
Verified: 2026-04-09 via PubMed E-utilities API

Source extracted via PubMed E-utilities API on 2026-04-09