TAVR and Anticoagulation: Direct Anticoagulant Agents or Vitamin K Inhibitors?

In some patients, using an anticoagulant agent is not an option, it is just prescribed. Based on the French TAVR registry, this research compared long-term mortality, bleeding, and ischemic events after valve implantation. A comparison was made between TAVR and direct vs. classic anticoagulant agents—good old proven and reversible vitamin K inhibitors.

TAVI y anticoagulación: ¿anticoagulantes directos o inhibidores de la vitamina K?

Cardiologists, hematologists, clinicians, and surgeons are still not sure about how to decide which drug to prescribe.

Two primary endpoints were defined: all-cause mortality (efficacy), and major bleeding (safety). Propensity score matching was used to compare both populations.

While 24,581 patients were screened, the final analysis only included 8962 patients (36.4%) who received vitamin K inhibitors and 2180 patients (24.3%) who were discharged with direct anticoagulant agents.

After 3 years of follow-up and adjusting through propensity score matching, both all-cause mortality (hazard ratio [HR]: 1.37; 95% confidence interval [CI]: 1.12 to 1.67; p < 0.005) and bleeding (HR: 1.64; 95% CI: 1.17 to 2.29; p < 0.005) favored direct anticoagulant agents.


Read also: New Evidence in Israel in Favor of Applying a Third Dose against COVID-19.


These data, combined with others, are starting to simplify post-procedure schemes. If the patient does not need anticoagulation, aspirin monotherapy suffices. On the other hand, if anticoagulation is needed, a direct inhibitor without any concomitant drugs should be prescribed.

Conclusions

This large French multicenter study with extensive follow-up of clinical events showed that direct anticoagulant agents reduce mortality and major bleeding. This research supports using direct inhibitors as the preferred option.

Original Title: TAVR Patients Requiring Anticoagulation: Direct Oral Anticoagulant or Vitamin K Antagonist?

Reference: Romain Didier et al. JACC Cardiovasc Interv. 2021 Aug 9;14(15):1704-1713. doi: 10.1016/j.jcin.2021.05.025.


Subscribe to our weekly newsletter

Get the latest scientific articles on interventional cardiology

More articles by this author

Percutaneous Treatment of Atrial Functional Mitral Regurgitation

Atrial functional mitral regurgitation (aFMR), which results from atrial dilation without significant left ventricular dysfunction, accounts for approximately one-third of mitral regurgitation (MR) cases...

ACURATE Neo2 Underexpansion: Prevalence and Clinical Implications

While transcatheter aortic valve replacement (TAVR) provides durable clinical benefits across a wide range of patients, technical challenges remain that may affect long-term outcomes....

Pretreatment with DAPT in Acute Coronary Syndrome: An Ongoing Debate?

In acute coronary syndrome (ACS) dual antiplatelet therapy (DAPT) has become a fundamental pillar after percutaneous coronary intervention (PCI), preventing stent thrombosis and acute...

Measuring Post-TAVI Gradients and Their Implications: Are Invasive and Echocardiographic Assessments Comparable?

Transcatheter aortic valve implantation (TAVI) is considered the treatment of choice for a significant proportion of patients with symptomatic aortic stenosis. Outcomes have improved...

LEAVE A REPLY

Please enter your comment!
Please enter your name here

Related Articles

SOLACI Sessionsspot_img

Recent Articles

Percutaneous Treatment of Atrial Functional Mitral Regurgitation

Atrial functional mitral regurgitation (aFMR), which results from atrial dilation without significant left ventricular dysfunction, accounts for approximately one-third of mitral regurgitation (MR) cases...

ACURATE Neo2 Underexpansion: Prevalence and Clinical Implications

While transcatheter aortic valve replacement (TAVR) provides durable clinical benefits across a wide range of patients, technical challenges remain that may affect long-term outcomes....

Spontaneous Left Main Dissection: Clinical Characteristics, management and Outcomes

Courtesy of Dr. Juan Manuel Pérez. Spontaneous left main dissection in an uncommon, and potentially life-threatening, cause of acute MI. The aim of this study,...