David Jochheim1, Marco Barbanti2, Giuliana Capretti3, Giulio G Stefanini4, Alexander Hapfelmeier5, Magda Zadrozny6, Moritz Baquet1, Julius Fischer6, Hans Theiss6, Denise Todaro2, Alaide Chieffo3, Patrizia Presbitero4, Antonio Colombo3, Steffen Massberg1, Corrado Tamburino2, Julinda Mehilli7. 1. Department of Cardiology, Munich University Clinic, Ludwig-Maximilians University, Munich, Germany; German Centre for Cardiovascular Research, partner site Munich Heart Alliance, Munich, Germany. 2. Department of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy. 3. Department of Cardiology, Università Vita-Salute San Raffaele, Milano, Italy. 4. Department of Cardiology, Istituto Clinico Humanitas, Rozzano, Italy. 5. Institute of Medical Informatics, Statistics and Epidemiology, Technical University Munich, Munich, Germany. 6. Department of Cardiology, Munich University Clinic, Ludwig-Maximilians University, Munich, Germany. 7. Department of Cardiology, Munich University Clinic, Ludwig-Maximilians University, Munich, Germany; German Centre for Cardiovascular Research, partner site Munich Heart Alliance, Munich, Germany. Electronic address: julinda.mehilli@med.uni-muenchen.de.
Abstract
OBJECTIVES: The purpose of the study was to investigate the impact of oral anticoagulation (OAC) type on clinical outcomes 1 year after transcatheter aortic valve replacement (TAVR). BACKGROUND: Non-vitamin K oral anticoagulants (NOACs) are superior to vitamin K antagonists (VKAs) in nonvalvular atrial fibrillation (AF), while their comparative performance among patients in need of OAC undergoing TAVR is underinvestigated. METHODS: The study enrolled 962 consecutive patients who underwent TAVR in 4 tertiary European centers and were discharged on either NOACs (n = 326) or VKAs (n = 636). By using propensity scores for inverse probability of treatment weighting (IPTW), the comparison of treatment groups was adjusted to correct for potential confounding. RESULTS: Mean age and Society of Thoracic Surgeons score of the population were 81.3 ± 6.3 years and 4.5% (interquartile range: 3.0% to 7.3%); 52.5% were women and a balloon-expandable valve was used in 62.7% of cases. The primary outcome of interest, combined incidence of all-cause mortality, myocardial infarction, and any cerebrovascular event at 1-year after TAVR, was 21.2% with NOACs versus 15.0% with VKAs (hazard ratio [HR]: 1.44; 95% confidence interval [CI]: 1.00 to 2.07; p = 0.050, IPTW-adjusted). The 1-year incidence of any Bleeding Academic Research Consortium bleeds and all-cause mortality were comparable between the NOAC and VKA groups, 33.9% versus 34.1% (HR: 0.97; 95% CI: 0.74 to 1.26; p = 0.838, IPTW-adjusted) and 16.5% versus 12.2% (HR: 1.36; 95% CI: 0.90 to 2.06; p = 0.136, IPTW-adjusted), respectively. CONCLUSIONS: Chronic use of both NOACs and VKAs among patients in need of OAC after TAVR are comparable regarding 1-year bleeding risk. The higher ischemic event rate observed with NOACs needs to be evaluated in large randomized trials.
OBJECTIVES: The purpose of the study was to investigate the impact of oral anticoagulation (OAC) type on clinical outcomes 1 year after transcatheter aortic valve replacement (TAVR). BACKGROUND: Non-vitamin K oral anticoagulants (NOACs) are superior to vitamin K antagonists (VKAs) in nonvalvular atrial fibrillation (AF), while their comparative performance among patients in need of OAC undergoing TAVR is underinvestigated. METHODS: The study enrolled 962 consecutive patients who underwent TAVR in 4 tertiary European centers and were discharged on either NOACs (n = 326) or VKAs (n = 636). By using propensity scores for inverse probability of treatment weighting (IPTW), the comparison of treatment groups was adjusted to correct for potential confounding. RESULTS: Mean age and Society of Thoracic Surgeons score of the population were 81.3 ± 6.3 years and 4.5% (interquartile range: 3.0% to 7.3%); 52.5% were women and a balloon-expandable valve was used in 62.7% of cases. The primary outcome of interest, combined incidence of all-cause mortality, myocardial infarction, and any cerebrovascular event at 1-year after TAVR, was 21.2% with NOACs versus 15.0% with VKAs (hazard ratio [HR]: 1.44; 95% confidence interval [CI]: 1.00 to 2.07; p = 0.050, IPTW-adjusted). The 1-year incidence of any Bleeding Academic Research Consortium bleeds and all-cause mortality were comparable between the NOAC and VKA groups, 33.9% versus 34.1% (HR: 0.97; 95% CI: 0.74 to 1.26; p = 0.838, IPTW-adjusted) and 16.5% versus 12.2% (HR: 1.36; 95% CI: 0.90 to 2.06; p = 0.136, IPTW-adjusted), respectively. CONCLUSIONS: Chronic use of both NOACs and VKAs among patients in need of OAC after TAVR are comparable regarding 1-year bleeding risk. The higher ischemic event rate observed with NOACs needs to be evaluated in large randomized trials.
Authors: Amanda Jia Qi Ooi; Chloe Wong; Timothy Wei Ern Tan; Trina Priscilla Ng; Yao Neng Teo; Yao Hao Teo; Nicholas L Syn; Andie H Djohan; Yinghao Lim; Leonard L L Yeo; Benjamin Y Q Tan; Mark Yan-Yee Chan; Kian-Keong Poh; William K F Kong; Ping Chai; Tiong-Cheng Yeo; James W Yip; Ivandito Kuntjoro; Ching-Hui Sia Journal: Eur J Clin Pharmacol Date: 2022-08-09 Impact factor: 3.064
Authors: Gloria Färber; Sabine Bleiziffer; Torsten Doenst; Dimitra Bon; Andreas Böning; Helge Weiler; Eva Herrmann; Christian Frerker; Andreas Beckmann; Helge Möllmann; Stephan Ensminger; Raffi Bekeredjian; Thomas Walther; Wolfgang Harringer; Hugo A Katus; Christian W Hamm; Friedhelm Beyersdorf; Timm Bauer; Stephan Fichtlscherer Journal: Clin Res Cardiol Date: 2020-09-23 Impact factor: 5.460
Authors: Line Melgaard; Thure Filskov Overvad; Martin Jensen; Thomas Decker Christensen; Gregory Y H Lip; Torben Bjerregaard Larsen; Peter Brønnum Nielsen Journal: J Am Heart Assoc Date: 2021-11-24 Impact factor: 6.106