Impact of Anticoagulation on Long-Term Bioprosthesis Durability After Transcatheter Aortic Valve Replacement

Leaflet thrombosis has emerged as a potential contributor to structural valve deterioration, raising interest in the role of oral anticoagulation (OAC) after transcatheter aortic valve replacement (TAVR). However, current data on the impact of OAC on valve durability are scarce and debated. The aim of this study was to investigate the impact of OAC on long-term bioprosthetic valve durability.

We analysed the data of a prospective registry including consecutive patients undergoing TAVR from May 2007 to January 2019 alive at 1 year. To reduce imbalance in baseline and procedural characteristics, the effect of OAC was assessed with the use of a propensity score-matched population (321 patients with OAC vs 559 patients without OAC). The primary end point was the occurrence of stage 2 or 3 hemodynamic valve deterioration (HVD) according to VARC-3 criteria.

In the propensity score-matched population, OAC was associated with a lower risk of stage 2 or 3 HVD occurrence compared with no OAC (6.9% vs 13.1%, subdistribution hazard ratio (sHR) 0.50, 95% CI 0.31-0.81; P = 0.005) after a median follow-up of 5 years (IQR 3-7 years). Long-term echocardiographic follow-up of up to 10-years showed better hemodynamic parameters over time in patients with OAC. OAC was associated with an increased risk of major bleeding events (13.7% vs 8.8%, sHR 1.66, 95% CI 1.10-2.50; P = 0.016).

OAC was associated with a lower incidence of stage 2 and 3 HVD, and improved valve hemodynamic parameters over time. This apparent benefit must be weighed against the increased risk of bleeding. Further studies exploring individualised antithrombotic strategies are warranted.