Author + information
- M Chadi Alraies1,
- Homam Moussa Pacha2,
- Kyle Buchanan3,
- Toby Rogers1,
- Edward Koifman1,
- Arie Steinvil4,
- Mohamad Soud1,
- Petros Okubagzi1,
- Linzhi Xu1,
- Rebecca Torguson3,
- Itshac Itsik Ben-Dor3,
- Lowell Satler3,
- Augusto Pichard3 and
- Ron Waksman5
- 1MedStar Washington Hospital Center, Washington, District of Columbia, United States
- 2Medstar Washingtion Hospital Center, Silver Spring, Maryland, United States
- 3Washington Hospital Center, Washington, District of Columbia, United States
- 4Medstar Washington Hospital center, Washington DC, USA, Washington, District of Columbia, United States
- 5Medstar Washington Hospital Center, Washington, District of Columbia, United States
Oral anticoagulation (OAC) management for atrial fibrillation (AF) patients vary following transcatheter aortic valve replacement (TAVR). Warfarin is standard of care for AF patients post TAVR. We evaluated antithrombotic use post TAVR and associated outcome.
Consecutive AF patients on OAC who underwent TAVR from 2007 to 2016 were included. Patients were divided into three groups: warfarin ± any antiplatelet, NOAC ± any antiplatelet, and dual antiplatelet.
Total of 331 AF patients were analyzed. Overall, 18% (n=58) were discharged on NOAC, 34% (112) on warfarin, 32% (106) on DAPT alone and 17% (n=55) were not eligible for OAC or antiplatelet therapy. Warfarin group was younger compared to others (p=0.008). Most patient’s characteristics were similar in all 3 groups; gender (p=0.069), HTN (p=0.18), DM (p=0.16), stroke (p=0.37), CHF (p=0.054), CAD (p=0.21), and PAD (p=0.98). There was no difference in rates of stroke (p=0.366), major (p=0.167) or minor bleeding (p= 0.233) between the 3 groups. Unadjusted 1 year mortality was not significantly different between warfarin, NOAC and DAPT groups (p=0.15), with trend toward lower mortality in NOAC when compared to warfarin alone (p=0.06) (figure). One-year adjusted risk of mortality was similar in NOAC and DAPT groups compared with warfarin (HR, 95% CI; 0.44, 0.18-1.01; 0.72, 0.39-1.31; respectively).
Compared with warfarin alone, NOAC is associated with similar rate of bleeding and stroke with trends toward lower 1-year mortality. Further studies are required for identifying the optimal antithrombotic strategy in TAVR patients with AF.
STRUCTURAL: Valvular Disease: Aortic