Against what common sense dictates, continuing oral anticoagulation pre- and post- transcatheter aortic valve replacement (TAVR) is safe, according to this article soon to be published in JACC Interventions. There was no increase in hemorrhagic or vascular complications and, paradoxically, those who continued using anticoagulant agents received fewer transfusions that those who did not.
A significant portion of patients who undergo TAVR have a prior indication for long-term oral anticoagulation. However, as the optimal management of these patients is unknown, the information used is usually based on other procedures. Generally, oral anticoagulation is suspended the days leading to the procedure—depending on the thrombosis risk—using a bridge with low molecular weight heparin.
All consecutive patients receiving oral anticoagulation undergoing transfemoral TAVR at 5 European centers were enrolled. Anticoagulation was either stopped 2 or 4 days before TAVR, or continued throughout the procedure. The primary safety endpoint was major bleeding, while secondary efficacy endpoints included vascular complications, stroke, and mortality.
About 584 patients continued with their previous anticoagulation scheme and 733 interrupted it.
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At 30 days, the major bleeding or life-threatening bleeding rate was 11.3% vs. 14.3% (odds ratio [OR]: 0.86; 95% confidence interval [CI]: 0.61 to 1.21; p = 0.39). Vascular complications were also pretty much identical among patients who continued using anticoagulation vs. those who stopped it (11% vs. 12.3%; OR: 0.89; 95% CI: 0.62 to 1.27; p = 0.52).
Transfusion was less often required in patients with continuation of anticoagulation and 12-month mortality was identical among them.
Conclusion
Continuing oral anticoagulation in patients who will undergo TAVR does not increase bleeding or vascular complications.
Original Title: Safety and Efficacy of Transcatheter Aortic Valve Replacement With Continuation of Vitamin K Antagonists or Direct Oral Anticoagulants.
Reference: Miriam Brinkert et al. J Am Coll Cardiol Intv 2020, article in press. https://doi.org/10.1016/j.jcin.2020.09.062.
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