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Published on: August 8, 2025
Real-World Anticoagulatory Treatment After Transcatheter Aortic Valve Replacement: A Retrospective, Observational
Christopher Hohmann1, Marion Ludwig2, Jochen Walker2
1Department III of Internal Medicine, Faculty of Medicine and University Hospital Cologne, Heart Center, University of Cologne, Cologne, Germany.
Insights
Post-transcatheter aortic valve replacement (TAVR) anticoagulant therapy deviates significantly from guidelines. Non-adherence increases mortality risk, highlighting the need for improved guideline adherence in TAVR patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Health Outcomes Research
Background:
- Transcatheter aortic valve replacement (TAVR) is a primary treatment for severe aortic stenosis in high-risk patients.
- Optimal anticoagulant therapy following TAVR remains an area of clinical debate and uncertainty.
Purpose of the Study:
- To analyze current anticoagulant treatment patterns after TAVR.
- To evaluate the clinical outcomes associated with different anticoagulant regimens post-TAVR.
Main Methods:
- Retrospective analysis of anonymized health claims data from approximately seven million German individuals (InGef database).
- Assessment of anticoagulant regimens within 90 days post-TAVR, with clinical events examined between 30 days and 6 months.
- Inclusion of 4,812 patients who underwent TAVR between 2014 and 2018.
Main Results:
- 68% of patients received TAVR treatment non-adherent to current guidelines.
- Oral anticoagulation (OAC) or no anticoagulation post-TAVR was associated with significantly increased all-cause mortality compared to antiplatelet monotherapy.
- Direct oral anticoagulants (DOACs) were used by 64% of patients on OAC.
Conclusions:
- Real-world TAVR treatment shows substantial deviations from established guideline recommendations.
- Significant differences in clinical outcomes across treatment groups necessitate further investigation into underlying causes and improved guideline adherence.
Abstract:
Background: Transcatheter aortic valve replacement (TAVR) has developed to the therapy of choice for patients with symptomatic severe aortic stenosis who are unsuitable for surgical aortic valve replacement and elderly patients with intermediate or high operative risk. However, the optimal anticoagulant therapy post-TAVR still remains a matter of debate. Aims: This study sought to investigate current anticoagulant treatment patterns and clinical outcome in patients undergoing TAVR. Methods: In a retrospective study based on anonymized health claims data of approximately seven million Germans with statutory health insurance (InGef database), anticoagulant treatment regimens were assessed using any drug prescription post discharge within the first 90 days after TAVR procedure. Clinical events between 30 days and 6 months were examined by treatment regime. Results: The study population comprised 4,812 patients with TAVR between 2014 and 2018: 29.4% received antiplatelet monotherapy, 17.8% dual antiplatelet therapy, 17.4% oral anticoagulation (OAC) plus antiplatelet therapy, 12.9% OAC monotherapy, 2.2% triple therapy and 19.2% did not receive any anticoagulatory drugs. Sixty-four percentage of patients with OAC received direct oral anticoagulants (DOAC). Hence, 68% of all patients were treated non-adherent to current guidelines. Forty percentage of patients with OAC prior to TAVR did not have any OAC after TAVR. The adjusted risk of all-cause mortality was significantly increased in patients with OAC (HR 1.40, 95% CI 1.03-1.90, p = 0.03) and no anticoagulatory treatment (HR 3.95, 95% CI 2.95-5.27, p < 0.0001) when compared to antiplatelet monotherapy. Conclusions: This large real-world data analysis demonstrates substantial deviations from guideline recommendations and treatment after TAVR. Considering relevant differences in clinical outcome across treatment groups, major effort is warranted to examine underlying causes and improve guideline adherence.
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