Interventions for valvular disease and heart failure

Continued non-vitamin K antagonist oral anticoagulants versus vitamin K antagonists during transcatheter aortic valve implantation

EuroIntervention 2023;18:e1066-e1076. DOI: 10.4244/EIJ-D-22-00521

Norman Mangner
Norman Mangner1, MD; Miriam Brinkert2, MD; Lukas S. Keller3, MD; Noriaki Moriyama4,5, MD; Daniel Hagemeyer6, MD; Stephan Haussig1, MD; Lisa Crusius1, MD; Richard Kobza7, MD; Mohamed Abdel-Wahab8, MD; Mika Laine4, MD; Stefan Stortecky6, MD; Thomas Pilgrim6, MD; Fabian Nietlispach9,10, MD; Frank Ruschitzka9, MD; Holger Thiele8, MD; Stefan Toggweiler7, MD; Axel Linke1, MD
1. Department of Internal Medicine and Cardiology, Heart Center Dresden, Technische Universität Dresden, Dresden, Germany; 2. Division of Cardiology, Medical University Department, Kantonsspital Aarau, Aarau, Switzerland; 3. Quebec Heart and Lung Institute, Laval University, Quebec, QC, Canada; 4. Division of Cardiology, Helsinki University Central Hospital, Helsinki, Finland; 5. Division of Cardiology, Shonan Kamakura General Hospital, Kamakura, Japan; 6. Department of Cardiology, University Hospital Bern, Bern, Switzerland; 7. Heart Center Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland; 8. Department of Internal Medicine/Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany; 9. Department of Cardiology, University Hospital Zurich, Zurich, Switzerland; 10. CardioVascular Center Zürich, Hirslanden Klinik im Park, Zürich, Switzerland

Background: One-third of patients undergoing transcatheter aortic valve implantation (TAVI) have an indication for long-term oral anticoagulation (OAC).

Aims: We aimed to investigate whether continued non-vitamin K antagonist oral anticoagulant (NOAC) therapy compared with continued vitamin K antagonist (VKA) therapy during TAVI is equally safe and effective. 

Methods: Consecutive patients on OAC with either NOAC or VKA undergoing transfemoral TAVI at five European centres were enrolled. The primary outcome measure was a composite of major/life-threatening bleeding, stroke, and all-cause mortality at 30 days.

Results: In total, 584 patients underwent TAVI under continued OAC with 294 (50.3%) patients receiving VKA and 290 (49.7%) patients receiving NOAC. At 30 days, the composite primary outcome had occurred in 51 (17.3%) versus 36 (12.4%) patients with continued VKA and with continued NOAC, respectively (odds ratio [OR] 0.68, 95% confidence interval [CI]: 0.43-1.07; p=0.092). Rates of major/life-threatening bleeding (OR 0.87, 95% CI: 0.52-1.47; p=0.606) and stroke (OR 1.02, 95% CI: 0.29-3.59; p=0.974) were not different between groups. In a multivariate Cox regression analysis, continued NOAC, compared with continued VKA, was associated with a lower risk for all-cause 1-year mortality (hazard ratio [HR] 0.61, 95% CI: 0.37-0.98; p=0.043). The analysis of the propensity score-matched cohort revealed similar results.

Conclusions: Continued NOAC compared with continued VKA during TAVI led to comparable outcomes with regard to the composite outcome measure indicating that continued OAC with both drugs is feasible. These hypothesis-generating results need to be confirmed by a dedicated randomised controlled trial.

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bleedingnon-vitamin K antagonist oral anticoagulantoral anticoagulationtranscatheter aortic valve implantationvitamin K antagonist
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