Transcatheter aortic valve replacement (TAVR) has consolidated as a valid strategy for certain groups of patients. However, approximately one third of those who require this therapy are being treated with anticoagulants (AC).
Even though the current guidelines suggest interrupting anticoagulation to reduce bleeding risk, the available evidence has not yet fully elucidated this recommendation.
This analysis of POPular PAUSE TAVI, included 858 patients treated with anticoagulants undergoing TAVR. 431 (50.2%) of these patients continued with AC (AC+), while the rest stopped AC and continued after procedure, according to treating physician criteria (AC-).
The primary outcome was a composite of cardiovascular death, stroke, infarction, vascular complications or major bleeding within 30 days after procedure.
Baseline group characteristics were similar: mean age 81, one third women, 3.8 STS Score, atrial fibrillation in 96% of cases, 4.5 CHA2DS2-VASc Score, 78% were hypertensive, 30% diabetic, 33% had a history of CABG, 15% had infarction history, 11% stroke, 10% TIA, 13% COPD, there was kidney function deterioration in 50% and prior TAVR in 7%.
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There were no differences in primary end point, with 16.5% incidence in AC+ patients vs 14.8% in AC- (risk difference: 1.7 percentual points, CI 95%: −3.1 to 6.6; P = 0.18 for non-inferiority). Neither were there differences in cardiovascular mortality, all cause stroke, infarction, major bleeding or major vascular complications.
Conclusion
In TAVR patients, periprocedural anticoagulation was shown non-inferior vs. AC interruption as regards the incidence of the combined end point of cardiovascular death, stroke, infarction, major vascular complications and major bleeding at 30 days.
Original Title: Continuation versus Interruption of Oral Anticoagulation during TAVI. POPular PAUSE TAVI Trial.
Reference: D.J. van Ginkel, et al. N Engl J Med 2025;392:438-49. DOI: 10.1056/NEJMoa2407794.
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