Oral Anticoagulant Type and Outcomes After Transcatheter Aortic Valve Replacement

Jochheim, David; Barbanti, Marco; Capretti, G; Stefanini, Giulio G.; Hapfelmeier, Alexander; Zadrozny, Magda; Baquet, Moritz; Fischer, Julius; Theiß, Hans; Todaro, Denise; Chieffo, Alaide; Presbitero, Patrizia; Colombo, Antonio; Maßberg, Steffen; Tamburino, Corrado; Mehilli, Julinda

doi:10.1016/j.jcin.2019.03.003

Cited by 100 publications

(65 citation statements)

References 26 publications

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“… 45 Similarly, 962 patients who underwent TAVR and were discharged on DOACs ( n = 326) or VKAs ( n = 636) were followed for 1 year, and there was no significant difference in the incidence of bleeding events, but ischemic events with DOACs need further study. 46 This study provided a new idea for TAVR with anticoagulant therapy for AF. More recently, Butt et al further indicated that treatment with DOACs was safe and effective.…”

Section: Anticoagulant Therapymentioning

confidence: 92%

Optimal antithrombotic therapy after transcatheter aortic valve replacement in patients with atrial fibrillation

Zeng

Cheng

Xia

et al. 2020

Therapeutic Advances in Chronic Disease

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Atrial fibrillation (AF) is prevalent in patients with aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR). Depending on the timing of AF detection, it is usually categorized as pre-existing AF or new-onset AF. Antiplatelet therapy, rather than a vitamin K antagonist, may be considered as the primary treatment for patients without an indication for oral anticoagulants who undergo TAVR. However, the optimal postprocedural antithrombotic regimen for patients with AF undergoing TAVR remains unknown. In this review, we briefly introduce the management strategies of antithrombotic therapy and list the evidence from related studies to elucidate the optimal antithrombotic management for patients with AF undergoing TAVR.

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Section: Anticoagulant Therapymentioning

confidence: 92%

Optimal antithrombotic therapy after transcatheter aortic valve replacement in patients with atrial fibrillation

Zeng

Cheng

Xia

et al. 2020

Therapeutic Advances in Chronic Disease

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“…After 1 year of follow-up from TAVR, the composite endpoint occurred in 21.2% of NOAC and 15.0% of VKA patients. Rates of bleeding and all-cause mortality were similar, but NOACs had a higher rate of ischemic events than VKA therapy [81]. In a systematic review of anticoagulation therapy in AF patients with valvular heart disease and bioprosthetic heart valves, edoxaban 30 mg was associated with the least rate of major bleeding compared to rivaroxaban, VKA, and other similar agents.…”

Section: Evidence From Clinical Trialsmentioning

confidence: 94%

Anticoagulation in Atrial Fibrillation Patients

Magnusson¹,

Pergolizzi²,

Wolf³

et al. 2020

Epidemiology and Treatment of Atrial Fibrillation

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Atrial fibrillation (AF) is the most common arrhythmia and may cause thromboembolic events, typically stroke. Advances in pharmacological approaches to anticoagulation and groundbreaking large randomized controlled trials of non-vitamin K antagonist oral anticoagulants (NOACs) have changed the paradigm of anticoagulation therapy. Furthermore, observational studies support the efficacy and safety of NOAC. Few studies address the differences among NOACs, but prescriptions should be based on a thorough understanding of their pharmacological differences, including interactions, side effects, reversibility, and practical approach. In a subset of patients with AF, warfarin may still be the preferable option. Consequently, an individualized approach to oral anticoagulation is crucial.

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“…Since numerous concerns about OAC seem to derive from the prevailing use of VKA, several investigations have compared DOAC to VKA in terms of efficacy and safety among TAVI patients. 87,109,110 Previous studies had rendered controversial results, probably due to the lack of randomisation and the small sample sizes. A recent multicentre non-randomised registry of TAVI patients requiring OAC compared a DOAC-based strategy (mostly rivaroxaban or apixaban) to a standard VKA strategy.…”

Section: Patients Without a Coexisting Indication For Anticoagulationmentioning

confidence: 99%

Anticoagulation after Transcatheter Aortic Valve Implantation: Current Status

Greco

Capodanno

2020

Interv Cardiol

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Transcatheter aortic valve implantation (TAVI) is the standard of care for symptomatic severe aortic stenosis. Antithrombotic therapy is required after TAVI to prevent thrombotic complications but it increases the risk of bleeding events. Current clinical guidelines are mostly driven by expert opinion and therefore yield low-grade recommendations. The optimal antithrombotic regimen following TAVI has yet to be determined and several randomised controlled trials assessing this issue are ongoing. The purpose of this article is to critically explore the impact of antithrombotic drugs, especially anticoagulants, on long-term clinical outcomes following successful TAVI.

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Oral Anticoagulant Type and Outcomes After Transcatheter Aortic Valve Replacement

Cited by 100 publications

References 26 publications

Optimal antithrombotic therapy after transcatheter aortic valve replacement in patients with atrial fibrillation

Optimal antithrombotic therapy after transcatheter aortic valve replacement in patients with atrial fibrillation

Anticoagulation in Atrial Fibrillation Patients

Anticoagulation after Transcatheter Aortic Valve Implantation: Current Status

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