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Updated: Jul 6, 2025
Fully Endoscopic Mitral Valve Repair with Percutaneous Cannulation of Groin Vessels
Published on: May 26, 2023
Comparison of Direct Oral Anticoagulants vs Vitamin K Antagonists After Transcatheter Mitral Valve Replacement
Nathan El Bèze1, Dominique Himbert2, Gaspard Suc2
1Department of Cardiology, Bichat Claude Bernard Hospital-Paris City University, Paris, France.
Insights
Direct oral anticoagulants (DOACs) show reduced bleeding and shorter hospital stays post-transcatheter mitral valve replacement (TMVR) compared to vitamin K antagonists (VKAs). This study suggests DOACs may be a safer option for TMVR patients without increasing thrombotic risks.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- No established antithrombotic treatment guidelines exist for transcatheter mitral valve replacement (TMVR).
- Vitamin K antagonists (VKAs) are currently the predominant treatment, based on analogy with surgical mitral bioprostheses.
Purpose of the Study:
- To compare bleeding and thrombotic events in patients undergoing transseptal TMVR with either direct oral anticoagulants (DOACs) or VKAs.
- To evaluate the safety and efficacy of DOACs versus VKAs in the TMVR population.
Main Methods:
- Prospective cohort study of 156 patients who underwent transseptal TMVR with a SAPIEN prosthesis (2011-2023).
- Patients received VKAs until October 2019, followed by DOACs.
- Primary outcome was bleeding events; median follow-up was 4.7 months.
Main Results:
- DOAC use was associated with a significantly lower incidence of bleeding events (9% in DOAC group vs. 40% in VKA group; adjusted HR: 0.21).
- DOAC treatment correlated with a shorter hospital stay.
- No significant differences were observed in thrombotic events, major vascular complications, stroke, or mortality between the groups.
Conclusions:
- Direct oral anticoagulants (DOACs) may reduce bleeding complications following transcatheter mitral valve replacement (TMVR) compared to VKAs.
- DOACs appear to decrease length of hospital stay without increasing thrombotic event risk.
- DOACs represent a potentially safer antithrombotic strategy for TMVR patients.
Background:
There is currently no established recommendation for antithrombotic treatment following transcatheter mitral valve replacement (TMVR). However, based on the analogy with surgical mitral bioprosthesis, vitamin K antagonists (VKAs) are predominantly used.
Objectives:
The purpose of this study was to compare bleeding and thrombotic events associated with direct oral anticoagulants (DOACs) or VKAs in a prospective cohort of TMVR patients.
Methods:
We enrolled consecutive patients who underwent transseptal TMVR using a SAPIEN family prosthesis at our center between 2011 and 2023. The primary outcome was the occurrence of bleeding. VKAs were administered to patients until October 2019, after which DOACs were prescribed. The median follow-up was 4.7 months (Q1-Q3: 2.6-6.7 months).
Results:
A total of 156 patients were included. The mean age was 65 ± 18.5 years, and 103 patients (66%) were women. The median EuroSCORE II was 7.48% (Q1-Q3: 3.80%-12.97%). Of the participants, 20.5% received DOACs and 79.5% were treated with VKAs. The primary outcome was observed in 50 (40%) patients in the VKA group and 3 (9%) patients in the DOAC group (adjusted HR: 0.21; 95% CI: 0.06-0.74; P = 0.02). Treatment with DOAC was associated with a shorter length of hospital stay. No significant differences were found in terms of thrombotic events, major vascular complications, stroke, or death.
Conclusions:
The use of DOACs after TMVR, compared with VKAs, appears to reduce the risk of bleeding complications and decrease the length of hospital stay for patients, without a significant increase in the risk of thrombotic events.
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