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Published on: February 28, 2012
Continued Versus Interrupted Oral Anticoagulation During Transcatheter Aortic Valve Replacement in Patients With
Hritvik Jain1, Nandan Patel1, Muhammad Daoud Tariq2
1Department of Cardiology, All India Institute of Medical Sciences (AIIMS), Jodhpur, India.
Insights
Continuing oral anticoagulation during transcatheter aortic valve replacement (TAVR) is safe and effective. This approach offers comparable outcomes to interrupting anticoagulation for patients requiring blood thinners.
Area of Science:
- Cardiology
- Interventional Cardiology
- Pharmacology
Background:
- Many patients undergoing transcatheter aortic valve replacement (TAVR) require long-term oral anticoagulation (OAC) due to comorbidities.
- The safety and efficacy of continuing OAC during TAVR versus interrupting it remain a critical clinical question.
Purpose of the Study:
- To evaluate the safety and effectiveness of periprocedural OAC continuation during TAVR compared to interruption.
- To provide evidence-based guidance for managing anticoagulation in TAVR patients with comorbidities.
Main Methods:
- A systematic literature search identified relevant studies for meta-analysis.
- Risk ratios (RR) with 95% confidence intervals (CIs) were calculated using a random-effects model.
- Statistical significance was defined as P < 0.05.
Main Results:
- Four studies involving 2962 patients (1318 continued OAC, 1644 interrupted OAC) were analyzed.
- Continued OAC demonstrated comparable risks for all-cause mortality, cardiovascular mortality, stroke, closure device failure, major bleeding, and vascular complications.
- Pooled analysis showed no significant differences in key adverse events between the two groups.
Conclusions:
- Continuing OAC during the periprocedural period of TAVR is a safe and effective strategy.
- This approach is a viable option for patients with atrial fibrillation or other conditions requiring anticoagulation.
- Findings support the continuation of OAC in select TAVR patients, simplifying management and potentially improving adherence.
Introduction:
A substantial number of patients undergoing transcatheter aortic valve replacement (TAVR) require long-term oral anticoagulants (OAC) owing to comorbidities. This study examined whether continuing oral anticoagulation periprocedurally during TAVR is as safe and effective as interrupting it.
Methods:
A systematic search of the major databases was performed to identify relevant studies. Effect estimates were calculated using risk ratios (RR) and 95% CIs by pooling the data using the inverse-variance random effects model. Statistical significance was set at P < 0.05.
Results:
Four studies were included, with 2962 patients undergoing TAVR with continued OAC (n = 1318) and interrupted OAC (n = 1644). The pooled analysis demonstrated that TAVR with continued OAC had comparable risks for all-cause mortality (RR: 0.91; 95% CI, 0.62-1.34; P = 0.64), cardiovascular mortality (RR: 0.89; 95% CI, 0.43-1.84; P = 0.76), stroke (RR: 0.67; 95% CI, 0.42-1.08; P = 0.09), closure device failure (RR: 0.86; 95% CI, 0.47-1.59; P = 0.64), major/life-threatening bleeding (RR: 0.93; 95% CI, 0.74-1.15; P = 0.49), and major vascular complications (RR: 0.97; 95% CI, 0.79-1.20; P = 0.80) compared with TAVR with interrupted OAC.
Conclusions:
In patients undergoing TAVR, continued OAC showed comparable safety and efficacy with interrupted OAC. These findings demonstrate that continuing OAC in the periprocedural period may be a viable option in patients with atrial fibrillation because of comorbidities requiring anticoagulants.
