Novel Oral Anticoagulants Versus Antiplatelet Therapy in Post-TAVR Patients: A Single-Center Retrospective Study

Background: The optimal antithrombotic therapy after transcatheter aortic valve replacement (TAVR) remains uncertain. Limited data exist comparing novel oral anticoagulants (NOACs) with standard antiplatelet therapy in this population. Methods: We conducted a retrospective analysis of 171 patients who underwent TAVR between January 2018 and August 2024. Patients were categorized according to the discharge antithrombotic regimen as follows: NOACs (n = 27, 16%), vitamin K antagonists (VKAs; n = 8, 5%), and antiplatelet therapy only (APT-only; aspirin and/or clopidogrel without oral anticoagulation; n = 136, 79%). Due to the small VKA sample size, the primary analysis compared NOACs with APT-only. VKA outcomes were reported descriptively without statistical comparisons. Results: Compared with APT-only, NOAC users had significantly higher 30-day mortality (33% vs. 12%, p = 0.017) and 1-year mortality (41% vs. 20%, p = 0.048). NOACs were associated with higher rates of major adverse cardiovascular events (MACCE) at 30 days (22% vs. 8%, p = 0.051) and 1 year (34% vs. 17%, p < 0.001). After inverse probability treatment weighting, NOACs showed increased odds of 30-day MACCE (OR 5.59, 95% CI 2.56-12.18, p < 0.001) and increased hazard of 1-year mortality (HR 2.22, 95% CI 1.22-4.03, p = 0.009). Conclusions: NOAC use was associated with inferior outcomes compared to antiplatelet therapy in post-TAVR patients, although residual confounding cannot be excluded. Given the limited sample size and retrospective design, these hypothesis-generating findings require validation in larger prospective studies before they can influence clinical practice.