Continued Versus Interrupted Oral Anticoagulation During Transfemoral Transcatheter Aortic Valve Implantation and Impact of Postoperative Anticoagulant Management on Outcome in Patients With Atrial Fibrillation

The role of continued versus interrupted oral anticoagulation (OAC) in patients with atrial fibrillation (AF) who underwent transfemoral transcatheter aortic valve implantation (TF-TAVI) for severe aortic stenosis is uncertain. The aim of this retrospective investigation was to evaluate the impact (...

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Bibliographic Details
Published in:The American journal of cardiology 2019-04, Vol.123 (7), p.1134-1141
Main Authors: Mangner, Norman, Crusius, Lisa, Haussig, Stephan, Woitek, Felix J., Kiefer, Philipp, Stachel, Georg, Leontyev, Sergey, Schlotter, Florian, Spindler, Aileen, Höllriegel, Robert, Hommel, Jennifer, Thiele, Holger, Borger, Michael A., Holzhey, David, Linke, Axel
Format: Article
Language:English
Subjects:
Administration, Oral
Aged
Aged, 80 and over
Anticoagulants
Anticoagulants - administration & dosage
Aortic stenosis
Aortic valve
Aortic Valve Stenosis - complications
Aortic Valve Stenosis - surgery
Atrial Fibrillation - complications
Atrial Fibrillation - drug therapy
Bleeding
Blood Coagulation
Cardiac arrhythmia
Cardiovascular disease
Consortia
Coronary vessels
Drug Administration Schedule
Female
Fibrillation
Follow-Up Studies
Germany - epidemiology
Heart
Humans
Implantation
Incidence
Intraoperative Period
Male
Mortality
Multivariate analysis
Patients
Postoperative Period
Renal failure
Retrospective Studies
Risk Assessment - methods
Risk Factors
Safety
Stenosis
Stroke
Stroke - epidemiology
Stroke - etiology
Stroke - prevention & control
Survival Rate - trends
Transcatheter Aortic Valve Replacement
Treatment Outcome
Vitamin K
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Summary:The role of continued versus interrupted oral anticoagulation (OAC) in patients with atrial fibrillation (AF) who underwent transfemoral transcatheter aortic valve implantation (TF-TAVI) for severe aortic stenosis is uncertain. The aim of this retrospective investigation was to evaluate the impact (1) of continued versus interrupted OAC on early safety and (2) of postoperative anticoagulant management on the 1-year mortality in patients with AF who underwent TF-TAVI. Consecutive patients with AF and on OAC at admission (n = 598) were stratified according to interrupted (iVKA) versus continued vitamin K antagonist (cVKA) versus continued direct oral anticoagulants (DOAC) at the time of TF-TAVI. Valve Academic Research Consortium-2 early safety was the primary outcome measure. Patients with iVKA (n = 299), cVKA (n = 117), and DOAC (n = 182) had comparable baseline characteristics including age (p = 0.25), gender (p = 0.33), and STS-Score (p = 0.072). The proportion of patients having a CHA2DS2-VASc-Score ≥3 (p = 0.791) and HAS-BLED-Score ≥3 (p = 0.185) was not different between groups. The rate of early safety events (with lower values indicating superior safety) was lowest in DOAC (13.2%) and not increased in cVKA (19.7%) compared to iVKA (23.1%) (p = 0.029). Valve Academic Research Consortium-2 defined stroke (p = 0.527) and bleeding (p = 0.097) did not differ between groups. Renal failure occurred more often in iVKA compared to cVKA and DOAC (p = 0.02). All-cause 1-year mortality was 20.1% in iVKA, 13.7% in cVKA, and 8.8% in DOAC (p = 0.015). Multivariate analysis revealed DOAC to be associated with reduced all-cause 1-year mortality (HR 0.56 (95%-CI 0.32 to 0.99), p = 0.047) whereas cVKA was comparable to iVKA (HR 0.75 (95%-CI 0.43 to 1.31), p = 0.307). In conclusion, cVKA did not increase the rate for the composite end point of early safety at 30 days in this cohort of patients. Treatment with a DOAC was associated with a significantly reduced rate of early safety end points at 30 days and lower 1-year mortality.
ISSN:0002-9149
1879-1913
DOI:10.1016/j.amjcard.2018.12.042