Impact of Anticoagulant Class on Long-Term Bioprosthesis Durability Following Transcatheter Aortic Valve Replacement

Vitamin K antagonists (VKAs) and direct oral anticoagulants (DOACs) have distinct biological properties that may differentially influence bioprosthetic valve durability following transcatheter aortic valve replacement. The aim of this study was to explore the effect of oral anticoagulation (OAC) class on bioprosthetic valve durability.

We analyzed the data of a prospective registry including 688 consecutive patients under OAC undergoing transcatheter aortic valve replacement between May 2007 and January 2024 who were alive at 1 year. The effect of OAC class was assessed using a propensity score-matched population (132 patients with VKA vs. 132 patients with DOAC). The primary endpoint was the occurrence of stage 2 or 3 hemodynamic valve deterioration according to Valve Academic Research Consortium-3 criteria.

In the propensity score-matched population, treatment with DOACs was not associated with a different risk of stage 2 or 3 hemodynamic valve deterioration compared to VKAs (subdistribution hazard ratio [sHR] 0.89; 95% CI 0.35-2.29; p = 0.808) after a median follow-up of 4 years (interquartile range: 3-5). No significant differences were observed for the risk of bioprosthetic valve failure (sHR 1.62; 95% CI 0.53-4.96; p = 0.401) or aortic valve reintervention (sHR 0.97; 95% CI 0.14-6.82; p = 0.981). Long-term echocardiographic follow-up showed similar evolution of hemodynamic parameters over time.

No significant differences were observed between VKAs and DOACs on valve durability outcomes. Further studies with longer follow-up, larger population, and randomized designs are warranted to confirm these findings.