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Non-Vitamin K Antagonist Versus Vitamin K Antagonist Oral Anticoagulant Agents After Transcatheter Aortic Valve Replacement. | LitMetric

AI Article Synopsis

  • There is limited research comparing the long-term outcomes of direct oral anticoagulants (DOACs) and vitamin K antagonist (VKA) agents after transcatheter aortic valve replacement (TAVR), leading to mixed results.
  • This study analyzed data from the SwissTAVI Registry to assess the safety and effectiveness of DOACs versus VKAs in patients undergoing TAVR, focusing on clinical outcomes at 30 days, 1 year, and 5 years.
  • Findings indicate that while VKAs are linked to higher all-cause mortality rates over 1 and 5 years, they also show a lower risk of disabling strokes compared to DOACs, with no significant differences in major bleeding events for either group

Article Abstract

Background: Studies comparing long-term outcomes between non-vitamin K antagonist (VKA) oral anticoagulant agents (direct oral anticoagulant agents [DOACs]) and VKA anticoagulant agents after transcatheter aortic valve replacement (TAVR) are scarce, with conflicting results.

Objectives: The aim of this study was to examine the periprocedural, short-term, and long-term safety and effectiveness of DOACs vs VKAs in patients undergoing TAVR via femoral access with concomitant indications for oral anticoagulation.

Methods: Consecutive patients undergoing transfemoral TAVR in the prospective national SwissTAVI Registry between February 2011 and June 2021 were analyzed. Net clinical benefit (a composite of all-cause mortality, myocardial infarction, stroke, and life-threatening or major bleeding) and the primary safety endpoint (a composite of life-threatening and major bleeding) were compared between the VKA and DOAC groups at 30 days, 1 year, and 5 years after TAVR.

Results: After 1:1 propensity score matching, 1,454 patients were available for analysis in each group. There was no significant difference in the rate of the net clinical benefit and the safety endpoints between the groups as assessed at 30 days and 1 and 5 years post-TAVR between VKAs and DOACs. VKAs were associated with significantly higher rates of 1- year (HR: 1.28; 95% CI: 1.01-1.62) and 5-year (HR: 1.25; 95% CI: 1.11-1.40) all-cause mortality. Long-term risk for disabling stroke was significantly lower in the VKA group after excluding periprocedural events (HR: 0.64; 95% CI: 0.46-0.90).

Conclusions: At 5 years after TAVR, VKAs are associated with a higher risk for all-cause mortality, a lower risk for disabling stroke, and a similar rate of life-threatening or major bleeding compared with DOACs. (SwissTAVI Registry; NCT01368250).

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Source
http://dx.doi.org/10.1016/j.jcin.2023.11.038DOI Listing

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