Direct oral anticoagulants versus vitamin K antagonist after transcatheter aortic valve implantation
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Direct oral anticoagulants versus vitamin K antagonist after transcatheter aortic valve implantation. / Hohmann, Christopher; Pfister, Roman; Frerker, Christian; Beckmann, Andreas; Walther, Thomas; Bleiziffer, Sabine; Ensminger, Stephan; Bekeredjian, Raffi; Seiffert, Moritz; Sinning, Jan-Malte; Möllmann, Helge; Beyersdorf, Friedhelm; Baldus, Stephan; Böning, Andreas; Herrmann, Eva; Balaban, Ümniye; Kuhn, Elmar; GARY Executive Board.
In: HEART, Vol. 109, No. 22, 26.10.2023, p. 1706-1713.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Direct oral anticoagulants versus vitamin K antagonist after transcatheter aortic valve implantation
AU - Hohmann, Christopher
AU - Pfister, Roman
AU - Frerker, Christian
AU - Beckmann, Andreas
AU - Walther, Thomas
AU - Bleiziffer, Sabine
AU - Ensminger, Stephan
AU - Bekeredjian, Raffi
AU - Seiffert, Moritz
AU - Sinning, Jan-Malte
AU - Möllmann, Helge
AU - Beyersdorf, Friedhelm
AU - Baldus, Stephan
AU - Böning, Andreas
AU - Herrmann, Eva
AU - Balaban, Ümniye
AU - Kuhn, Elmar
AU - GARY Executive Board
N1 - © Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.
PY - 2023/10/26
Y1 - 2023/10/26
N2 - OBJECTIVE: After transcatheter aortic valve implantation (TAVI), the optimal regimen of anticoagulant therapy in patients with an additional indication for oral anticoagulation remains a matter of debate. This study investigates the efficacy of direct oral anticoagulants (DOACs) versus vitamin K antagonists (VKAs) in patients after TAVI in a real-world population.METHODS: The German Aortic Valve RegistrY (GARY) is a prospective, multicentre registry enrolling patients undergoing invasive treatment for aortic valve disease. From January 2011 to December 2019, 1 41 790 patients from 92 hospitals in Germany were enrolled. Anticoagulatory treatment regimens were assessed at hospital discharge for patients after TAVI procedures. All-cause mortality and the combined endpoint 'cardiac and cerebrovascular events' containing myocardial infarction, stroke, transient ischaemic attack, aortic prosthesis reintervention and all-cause mortality in the first year after TAVI were examined by treatment regimen.RESULTS: Of 45 598 patients (mean age 80.7±5.7 years, 49.3% males) undergoing TAVI, 16 974 patients (37.2%) received an anticoagulant regimen that included VKA or DOAC. Hereof, the majority of patients were prescribed VKA (n=11 333, 66.8%) compared with DOAC (n=5641, 33.2%) with an increase of DOAC use from 9.4% in 2011 to 69.9% in 2019. During the 1-year follow-up, the absolute event rates per 100 person-years for all-cause mortality and the combined endpoint cardiac and cerebrovascular events were 1.9 and 1.3 for VKA-treated and 1.7 and 1.2 for DOAC-treated patients, respectively. After adjustment for baseline confounders, all-cause mortality (HR 0.95, 95% CI 0.88 to 1.01, p=0.114) and cardiac and cerebrovascular event-free survival (HR 0.93, 95% CI 0.86 to 1.01, p=0.071) did not differ significantly between VKA and DOAC groups.CONCLUSIONS: This study supports evidence of the efficacy of DOAC use after TAVI in patients with an indication for oral anticoagulation.
AB - OBJECTIVE: After transcatheter aortic valve implantation (TAVI), the optimal regimen of anticoagulant therapy in patients with an additional indication for oral anticoagulation remains a matter of debate. This study investigates the efficacy of direct oral anticoagulants (DOACs) versus vitamin K antagonists (VKAs) in patients after TAVI in a real-world population.METHODS: The German Aortic Valve RegistrY (GARY) is a prospective, multicentre registry enrolling patients undergoing invasive treatment for aortic valve disease. From January 2011 to December 2019, 1 41 790 patients from 92 hospitals in Germany were enrolled. Anticoagulatory treatment regimens were assessed at hospital discharge for patients after TAVI procedures. All-cause mortality and the combined endpoint 'cardiac and cerebrovascular events' containing myocardial infarction, stroke, transient ischaemic attack, aortic prosthesis reintervention and all-cause mortality in the first year after TAVI were examined by treatment regimen.RESULTS: Of 45 598 patients (mean age 80.7±5.7 years, 49.3% males) undergoing TAVI, 16 974 patients (37.2%) received an anticoagulant regimen that included VKA or DOAC. Hereof, the majority of patients were prescribed VKA (n=11 333, 66.8%) compared with DOAC (n=5641, 33.2%) with an increase of DOAC use from 9.4% in 2011 to 69.9% in 2019. During the 1-year follow-up, the absolute event rates per 100 person-years for all-cause mortality and the combined endpoint cardiac and cerebrovascular events were 1.9 and 1.3 for VKA-treated and 1.7 and 1.2 for DOAC-treated patients, respectively. After adjustment for baseline confounders, all-cause mortality (HR 0.95, 95% CI 0.88 to 1.01, p=0.114) and cardiac and cerebrovascular event-free survival (HR 0.93, 95% CI 0.86 to 1.01, p=0.071) did not differ significantly between VKA and DOAC groups.CONCLUSIONS: This study supports evidence of the efficacy of DOAC use after TAVI in patients with an indication for oral anticoagulation.
KW - Male
KW - Humans
KW - Aged
KW - Aged, 80 and over
KW - Female
KW - Transcatheter Aortic Valve Replacement/adverse effects
KW - Prospective Studies
KW - Anticoagulants/adverse effects
KW - Aortic Valve/surgery
KW - Aortic Valve Stenosis
KW - Fibrinolytic Agents
KW - Vitamin K
KW - Treatment Outcome
KW - Risk Factors
U2 - 10.1136/heartjnl-2023-322548
DO - 10.1136/heartjnl-2023-322548
M3 - SCORING: Journal article
C2 - 37407220
VL - 109
SP - 1706
EP - 1713
JO - HEART
JF - HEART
SN - 1355-6037
IS - 22
ER -
