TAVR Patients Requiring Anticoagulation: Direct Oral Anticoagulant or Vitamin K Antagonist?

Area of Science:

• Cardiology
• Interventional Cardiology
• Pharmacology

Background:

• The optimal anticoagulant for patients undergoing transcatheter aortic valve replacement (TAVR) is a subject of ongoing clinical debate.
• Patients with TAVR often require oral anticoagulation, necessitating a clear understanding of the risks and benefits associated with different anticoagulant classes.

Purpose of the Study:

• To compare the long-term safety and efficacy of direct oral anticoagulants (DOACs) versus vitamin K antagonists (VKAs) in patients requiring oral anticoagulation after TAVR.
• To evaluate rates of mortality, major bleeding, and ischemic events in these patient populations.

Main Methods:

• Utilized French TAVR registries (France-TAVI and FRANCE-2) linked with nationwide administrative healthcare databases (2010-2017).
• Employed propensity score matching to mitigate treatment-selection bias between DOAC and VKA groups.
• Assessed all-cause mortality and major bleeding as primary safety and efficacy endpoints.

Main Results:

• Among 8,962 patients on oral anticoagulation post-TAVR, 2,180 received DOACs.
• After propensity matching, DOAC use was associated with significantly lower 3-year all-cause mortality (HR: 1.37) and major bleeding including hemorrhagic stroke (HR: 1.64) compared to VKAs.
• No significant differences were observed in the rates of ischemic stroke or acute coronary syndrome between the DOAC and VKA groups.

Conclusions:

• This large-scale study demonstrates that direct oral anticoagulants (DOACs) are associated with reduced long-term mortality and major bleeding events compared to vitamin K antagonists (VKAs) in patients treated with TAVR.
• The findings support the preferential use of DOACs over VKAs for anticoagulation therapy in the TAVR population.