Do NOACs Result in Any Benefit in TAVR?

Courtesy of Dr. Carlos Fava.

The need for anticoagulation after transcatheter aortic valve replacement (TAVR) is over 15% according to different reports and, so far, no one has analyzed in depth whether new oral anticoagulant agents (non-vitamin K oral anticoagulants [NOACs]) result in superior benefit compared with classic vitamin K antagonists (VKAs).

This study analyzed 962 patients. Among them, 326 received NOACs (33.9%) and 636 received VKAs (66.1%).

The primary endpoint at 12 months was a composite of all-cause mortality, acute myocardial infarction, and stroke.

Groups were similar: the mean age was 81 years, 52% of patients were women, the Society of Thoracic Surgeons (STS) score was 4.5%, and the CHA2DS2 VASC Score ≥2, 95.2%. Balloon-expandable valves were the most used valves.

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At 30 days, there were no differences in mortality, major bleeding, or life-threatening bleeding, but NOAC patients had higher rates of non-disabling stroke compared with VKA patients (1.2% vs. 0%; p < 0.001).

At 1 year, the primary endpoint was higher for NOAC patients (20.9% vs. 14.4%; hazard ratio [HR] 1.47; 95% confidence interval [CI]: 1.06 to 2.04; p 0 = 0.018); there were no differences as regards mortality, acute myocardial infarction, or bleeding. The rates of non-disabling stroke were higher for NOAC patients (1.6% vs. 0.3%; HR: 5.00; 95% CI: 0.97 to 25.81; p = 0.054).

Conclusion

Chronic use of NOACs and VKAs among patients in need of oral anticoagulation after TAVR resulted in comparable bleeding risk at 1 year. NOACs resulted in a higher ischemic event rate, something that should be evaluated in large randomized trials.

Courtesy of Dr. Carlos Fava.

Original Title: Oral Anticoagulant Type and Outcomes After Transcatheter Aortic Valve Replacement.

Reference: David Jochheim, et al. JACC cardiovasc Interven. Article in press.

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