Early Transcatheter Aortic Valve Function With and Without Therapeutic Anticoagulation

Area of Science:

• Cardiology
• Interventional Cardiology
• Biomedical Engineering

Background:

• Prosthetic leaflet thrombosis is an emerging complication following transcatheter aortic valve replacement (TAVR).
• Current guidelines lack definitive recommendations for antiplatelet and anticoagulation therapies post-TAVR.
• Evidence is needed to clarify the effect of anticoagulation on prosthetic valve performance after TAVR.

Purpose of the Study:

• To investigate the impact of anticoagulant use on prosthetic valve function in patients who underwent TAVR.
• To assess early changes in valve hemodynamics (peak velocity and mean gradient) in relation to anticoagulation status.

Main Methods:

• Retrospective analysis of 403 patients undergoing native-valve TAVR between 2012 and 2015.
• Patients were stratified based on anticoagulant use at hospital discharge.
• Transthoracic echocardiograms were used to measure prosthetic valve peak velocity and mean gradient immediately post-TAVR and at 4-week follow-up.
• Multivariate regression analyses were employed to evaluate the association between anticoagulation and early TAVR valve performance.

Main Results:

• 29.6% of patients were discharged on anticoagulation.
• No significant differences in mean or peak prosthetic valve gradients or velocities were observed between anticoagulated and non-anticoagulated groups immediately post-implant or at 4-week follow-up.
• These findings remained consistent after multivariate adjustment (P=.80 for delta mean gradient; P=.91 for delta peak velocity).

Conclusions:

• The absence of anticoagulation therapy is not associated with short-term impairment of TAVR prosthetic valve performance.
• These results do not support the routine administration of anticoagulation following native-valve TAVR.