DOACs vs warfarin in patients undergoing transcatheter aortic valve implantation

  • Kalogeras K & al.
  • J Thromb Thrombolysis
  • 11 Oct 2019

  • curated by Sarfaroj Khan
  • UK Clinical Digest
Access to the full content of this site is available only to registered healthcare professionals. Access to the full content of this site is available only to registered healthcare professionals.

Takeaway

  • 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

Study design

  • 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.

Key results

  • 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).

Limitations

  • Selection bias.
  • Risk of confounding.

Please confirm your acceptance

To gain full access to GPnotebook please confirm:

By submitting here you confirm that you have accepted Terms of Use and Privacy Policy of GPnotebook.

Submit