- Patients treated with transcatheter aortic valve implantation (TAVI) with an indication for oral anticoagulation treated with a direct oral anticoagulant (DOAC) had similar 1 and 2-year survival to those treated with warfarin.
- In-hospital bleeding rates, including major and life-threatening events, were similar between the two anticoagulation groups.
Why this matters
- Findings suggest that DOACs are a safe and effective alternative option to warfarin in patients following TAVI with a concomitant indication for oral anticoagulation
- This study included 217 patients from the Athens-Tokyo-London-Aortic-Stenosis (ATLAS) registry who required anticoagulation post-TAVI and treated with warfarin (n=102) or DOACs (n=115).
- Propensity score matching (1:1) of patients in the warfarin vs DOAC groups was performed.
- Primary outcome: 30-day survival and Kaplan-Meier estimated 1-year, 2-year survival.
- Secondary outcome: Bleeding Academic Research Consortium (BARC) defined bleeding complications (in-hospital major or life-threatening bleeding).
- Funding: None disclosed.
- Warfarin vs DOACs group did not differ in:
- Kaplan-Meier estimated 1-year (90.6% vs 93.7%) and 2-year (84.5% vs 88.5%) survival (for both Plog-rank=.984),
- all-cause mortality risk (HR, 1.15; 95% CI, 0.33-4.04; P=.829),
- 30-day survival (0% vs 0.9%; P=1.000) and
- major and life-threatening bleeding complications (6% vs 8%; P=.857).
- After propensity score matching similar results were observed.
- During a median follow-up of 19.8 (interquartile range, 9.6-27.8) months, no significant difference was observed in the Kaplan-Meier estimated 1-year survival between 2 groups (96.7% vs 94.7%; Plog-rank=.857).
- Selection bias.
- Risk of confounding.