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
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  • 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).


  • Selection bias.
  • Risk of confounding.