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.
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.
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