Author + information
- M. Chadi Alraies1,
- Homam Moussa Pacha2,
- Kyle Buchanan3,
- Arie Steinvil4,
- Toby Rogers1,
- Edward Koifman1,
- Fahed Darmoch5,
- Petros Okubagzi1,
- Rebecca Torguson3,
- Linzhi Xu1,
- Itsik Ben-Dor6,
- Augusto Pichard3,
- Lowell Satler3 and
- Ron Waksman6
- 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
- 5Case Western Reserve University/ St Vincent medical center, Cleveland, Ohio, United States
- 6Medstar Washington Hospital Center, Washington, District of Columbia, United States
Current guidelines recommend dual anti-platelets therapy (DAPT) for all patient post transcatheter aortic valve replacement (TAVR). However, oral anticoagulants (OAC) have been used for high risk patients who are at increased risk for leaflet thrombosis post TAVR.
Consecutive patients who underwent TAVR procedure between 2007 and 2016 were included. Patients with the diagnosis of AF or atrial flutter were excluded from the study. Based on discharge medications, patients were divided into three groups: warfarin ± dual antiplatelet therapy (DAPT), non-vitamin K OAC (NOAC) ± DAPT, and DAPT. 30-day and 1-year outcome were captured using Kaplan Meier analysis.
462 patients (mean age 82 years, 47% men) were analyzed. Overall, 3% (n=16) were discharged on non-vitamin K OAC (NOAC), 6% (26) on warfarin, 68% (314) on dual antiplatelet therapy (DAPT) alone and 23% (n=106) did not receive the previous regimens. Patients discharged on NOAC were younger compared to other groups (p=0.015). There was no difference in rates of stroke (p=0.15), major (p=0.086) or minor bleeding (p= 0.36) between the 3 groups. Unadjusted 1 year mortality was significantly higher in warfarin group compared to NOAC and DAPT groups (p=0.013). In comparison to DAPT group, one-year adjusted risk of mortality was significantly higher in warfarin group (HR, 95% CI; 3.11, 1.37-7.05), and similar between NOAC and DAPT groups (HR, 95% CI; 0.66, 0.09-4.83).
The use of warfarin after TAVR in non-AF patients is associated with increased 1-year mortality. Antiplatelets might be enough post TAVR.