Safety and Efficacy of Transcatheter Aortic Valve Replacement With Continuation of Vitamin K Antagonists or Direct Oral Anticoagulants

• Published in: JACC. Cardiovascular interventions Vol. 14; no. 2; pp. 135 - 144
• Main Authors: Brinkert, Miriam, Mangner, Norman, Moriyama, Noriaki, Keller, Lukas S., Hagemeyer, Daniel, Crusius, Lisa, Lehnick, Dirk, Kobza, Richard, Abdel-Wahab, Mohamed, Laine, Mika, Stortecky, Stefan, Pilgrim, Thomas, Nietlispach, Fabian, Ruschitzka, Frank, Thiele, Holger, Linke, Axel, Toggweiler, Stefan
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 25.01.2021
• Subjects: aortic stenosis; bleeding; direct oral anticoagulant; oral anticoagulation; bleeding; OR; CI; PRBC; IQR; INR; DOAC; VKA; direct oral anticoagulant; TAVR; aortic stenosis; VARC; oral anticoagulation; BMI
• ISSN: 1936-8798; 1876-7605; 1876-7605
• DOI: 10.1016/j.jcin.2020.09.062

This study investigated whether transcatheter aortic valve replacement (TAVR) with peri-procedural continuation of oral anticoagulation is equally safe and efficacious as TAVR with peri-procedural interruption of anticoagulation. A significant proportion of patients undergoing TAVR have an indication for long-term oral anticoagulation. The optimal peri-procedural management of such patients is unknown. Consecutive patients on oral anticoagulation who underwent transfemoral TAVR at 5 European centers were enrolled. Oral anticoagulation was either stopped 2 to 4 days before TAVR or continued throughout the procedure. Primary safety outcome was major bleeding. Secondary efficacy endpoints included vascular complications, stroke, and mortality. Of 4,459 patients, 584 patients were treated with continuation of anticoagulation and 733 with interruption of anticoagulation. At 30 days, major or life-threatening bleedings occurred in 66 (11.3%) versus 105 (14.3%; odds ratio [OR]: 0.86; 95% confidence interval [CI]: 0.61 to 1.21; p = 0.39) and major vascular complications in 64 (11.0%) versus 90 (12.3%; OR: 0.89; CI: 0.62 to 1.27; p = 0.52) of patients with continuation and with interruption of anticoagulation, respectively. Transfusion of packed red blood cells was less often required in patients with continuation of anticoagulation (80 [13.7%] vs. 130 [17.7%]; OR: 0.59; 95% CI: 0.42 to 0.81; p = 0.001). Kaplan-Meier estimates of survival at 12 months were 85.3% in patients with continuation of anticoagulation and 84.0% in patients with interruption of anticoagulation (hazard ratio: 0.90; 95% CI: 0.73 to 1.12; p = 0.36). Continuation of oral anticoagulation throughout TAVR did not increase bleeding or vascular complication rates. Moreover, packed red blood cell transfusions were less often required in patients with continuation of oral anticoagulation. [Display omitted]