 o enfermedad adquirida de von Willebrand, lo que a menudo requiere tratamiento con anticoagulantes orales (ACO).){kind=link}
Due to their advanced age and comorbidities, many patients with severe aortic stenosis scheduled for transcatheter aortic valve implantation (TAVI) have atrial fibrillation (35%) or acquired von Willebrand disease, which often requires treatment with oral anticoagulants (OAC).
Researchers conducted a randomized study that included 858 patients in 22 European centers. These patients were randomized 1:1to either continue or discontinue anticoagulant treatment. The primary endpoint was the incidence of adverse events (cardiovascular mortality, stroke, myocardial infarction, major vascular complication, or major bleeding) 30 days after TAVI.
Regarding the primary endpoint, the event rate was 16.5% for the group that continued with OAC and 14.8% for the group that interrupted treatment, with a difference of 1.7% (95% confidence interval [CI] -3.1 to 6.6; p-noninferiority = 0.18). This indicates that continuing anticoagulant treatment was not noninferior to discontinuation.
As for secondary events, the risk of any type of bleeding was higher in the continuation group (difference of 9.8%; 95% CI 3.9-15.6), mainly affecting minor bleeding, although there were some cases of major bleeding.
The authors concluded that there was no advantage in continuing anticoagulant treatment and emphasized that this is the first randomized study supporting the discontinuation of OAC prior to TAVI implantation.
Presented by Dirk Jan van Ginkel at the Hot-Line Sessions, ESC Congress 2024, August 30-September 2, London, England.
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