Continued Versus Interrupted Oral Anticoagulation During Transfemoral Transcatheter Aortic Valve Implantation and Impact of Postoperative Anticoagulant Management on Outcome in Patients With Atrial Fibrillation

Mangner, Norman; Crusius, Lisa; Haußig, Stephan; Woitek, Felix; Kiefer, Philipp; Stachel, Georg; Leontyev, Sergey; Schlotter, Florian; Spindler, Aileen; Höllriegel, Robert; Hommel, Jennifer; Thiele, Holger; Borger, Michael A.; Holzhey, David; Linke, Axel

doi:10.1016/j.amjcard.2018.12.042

Cited by 41 publications

(31 citation statements)

References 28 publications

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“…Continued VKA had similar incidence of bleeding and access site complication than interrupted VKA. 4 These results are in line with the previous ones in which several DOAC regimens [dabigatran 5 ; edoxaban 6 ; apixaban 7 ; rivaroxaban 8 ] were compared to warfarin in patients with atrial fibrillation. Considering the lack of evidence and guideline-based recommendations on the best pre-TAVI OAC management, this study aims to evaluate the impact of continued OAC.…”

supporting

confidence: 90%

“…18 Supplementary Table 4 presents TAVI outcomes observed in the present study in the context of current literature. 1,2,4,14,19,20 Although the present study had not observed differences in both, primary and secondary outcomes, patients on OAC presented a higher 30-day mortality rate (0.9% no-OAC vs 4.3% OAC, p = 0.033). Nonetheless, only 1 of the 5 deaths observed in the OAC group could be associated or worsened by anticoagulation (intraprocedural cardiac tamponade).…”

Section: Discussioncontrasting

confidence: 67%

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Pre-Operative Continued Oral Anticoagulation Impact on Early Outcomes after Transcatheter Aortic Valve Implantation

Tagliari

Pérez-Camargo

Ferrari

et al. 2021

The American Journal of Cardiology

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supporting

confidence: 90%

Section: Discussioncontrasting

confidence: 67%

Pre-Operative Continued Oral Anticoagulation Impact on Early Outcomes after Transcatheter Aortic Valve Implantation

Tagliari

Pérez-Camargo

Ferrari

et al. 2021

The American Journal of Cardiology

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“…27 Retrospective analyses of two smaller registries from Germany or Switzerland including 371 or 598 patients found that established anticoagulation was interrupted in approximately 50% of cases without significant difference in lifethreatening or major bleedings between patients with continued versus interrupted anticoagulation. 28,29 In contrast, in a recent prospective trial life-threatening bleeding within 30 days after TAVR occurred 4.9-fold more often in patients with AF (4.4%) compared with sinus rhythm (0.9%), although anticoagulation therapy was interrupted until 48 hours after TAVR. 7 This raises the question whether other factors than anticoagulation may contribute to the increased bleeding risk in patients with AF.…”

Section: Thrombosis and Haemostasismentioning

confidence: 93%

Bleeding Complications Drive In-Hospital Mortality of Patients with Atrial Fibrillation after Transcatheter Aortic Valve Replacement

et al. 2020

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Background Atrial fibrillation (AF) is a risk factor for poor postoperative outcome after transfemoral transcatheter aortic valve replacement (TF-TAVR). The present study analyses the outcomes after TF-TAVR in patients with or without AF and identifies independent predictors for in-hospital mortality in clinical practice. Methods and Results Among all 57,050 patients undergoing isolated TF-TAVR between 2008 and 2016 in Germany, 44.2% of patients (n = 25,309) had AF. Patients with AF were at higher risk for unfavorable in-hospital outcome after TAVR. Including all baseline characteristics for a risk-adjusted comparison, AF was an independent risk factor for in-hospital mortality after TAVR. Among patients with AF, EuroSCORE, New York Heart Association classification class, or renal disease had only moderate effects on mortality, while the occurrence of postprocedural stroke or moderate to major bleeding substantially increased in-hospital mortality (odds ratio [OR] 3.35, 95% confidence interval [CI] 2.61–4.30, p < 0.001 and OR 3.12, 95% CI 2.68–3.62, p < 0.001). However, the strongest independent predictor for in-hospital mortality among patients with AF was severe bleeding (OR 18.00, 95% CI 15.22–21.30, p < 0.001). Conclusion The present study demonstrates that the incidence of bleeding defines the in-hospital outcome of patients with AF after TF-TAVR. Thus, the periprocedural phase demands particular care in bleeding prevention.

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“…While OAC therapy typically consists of a Vitamin K Antagonist (VKA) such as warfarin, studies have started to investigate the efficacy of novel direct oral anticoagulants (DOAC) in the treatment of AF post TAVI. While treatment with continuous VKA did not show any increase in safety, treatment with DOAC was associated with a significantly reduced rate of 1-year mortality [47]. One example of a DOAC is rivaroxaban, a direct factor Xa inhibitor and the most commonly used non VKA anticoagulant.…”

Section: Managementmentioning

confidence: 99%

A Review of the Incidence and Management of New-Onset Atrial Fibrillation Post Transcatheter Aortic Valve Implantation

Saxena¹

2020

AJBSR

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Transcatheter Aortic Valve Implantation (TAVI) is an established treatment option for patients with aortic stenosis who are considered highrisk for surgical valve replacement. New-onset atrial fibrillation (NOAF) is a serious adverse event post TAVI that is predictive of poor outcomes and whose pathophysiology remains unclear. The incidence of NOAF post-TAVI has a reportedly broad range depending on the study but has been correlated to procedure approach, choice of valve, and the use of general anesthesia. While surgical aortic valve replacement (SAVR) has traditionally been the preferred treatment for aortic stenosis, recent studies have demonstrated the benefits of expanding TAVI into a larger patient population. Additionally, the management of NOAF post-TAVI remains highly variable. This review paper aims to summarize the incidence of NOAF and to outline management strategies.The risk factors for NOAF post-TAVI is an ongoing area of research with many questions remaining to be answered. With the expansion of TAVI into lower-risk patient populations, it is imperative that risk factors for NOAF be determined in order to decrease the likelihood of stroke and mortality after the procedure. Data is still limited on standardized treatment for NOAF, but multiple international drug trials are aiming to discern the optimal anti-platelet and anti-coagulation treatment to improve post-procedure outcomes.

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Continued Versus Interrupted Oral Anticoagulation During Transfemoral Transcatheter Aortic Valve Implantation and Impact of Postoperative Anticoagulant Management on Outcome in Patients With Atrial Fibrillation

Cited by 41 publications

References 28 publications

Pre-Operative Continued Oral Anticoagulation Impact on Early Outcomes after Transcatheter Aortic Valve Implantation

Pre-Operative Continued Oral Anticoagulation Impact on Early Outcomes after Transcatheter Aortic Valve Implantation

Bleeding Complications Drive In-Hospital Mortality of Patients with Atrial Fibrillation after Transcatheter Aortic Valve Replacement

A Review of the Incidence and Management of New-Onset Atrial Fibrillation Post Transcatheter Aortic Valve Implantation

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