Author + information
- Felix Woitek1,
- Lisa Crusius2,
- Norman Mangner1,
- Aileen Spindler2,
- Stephan Haussig1,
- Georg Stachel1,
- Florian Schlotter3,
- Philipp Kiefer2,
- Sergey Leontyev1,
- David Michael Holzhey4,
- Friedrich-Wilhelm Mohr5,
- Gerhard Schuler4 and
- Axel Linke6
- 1University of Leipzig - Heart Center, Leipzig, Germany
- 2University of Leipzig - Heart Center Leipzig, Leipzig, Germany
- 3University of Leipzig - Heart Center Leipzig, Struempellstrasse 39, Germany
- 4Heart Center, Leipzig, Germany
- 5Heart Center Leipzig, Leipzig, Germany
- 6University of Leipzig Heart Center, Leipzig, Germany
Transcatheter aortic valve replacement (TAVR) has become the alternative to surgical aortic valve replacement in intermediate and high risk patients (pts) with severe aortic valve stenosis. However, new-onset of atrial fibrillation, early valve thrombosis and bleeding events may complicate the post-interventional course. The treatment after TAVR is so far determined empirically, thus the aim of this analysis was to determine the influence of oral anticoagulation vs. any anti-platelet strategy following TAVR.
Pts with severe aortic stenosis in which TAVR was performed between 2006 and 2015 were considered in the study. Decision for TAVR was made by an experienced heart team. All endpoint-related events were fully adjudicated according to the VARC2 definitions.
A total of 2529pts (age 80.3±6.0years, logEuroSCORE 18.6±13.1%, STS Score 8.2±6.0%, EuroSCORE II 6.7±6.5%) were included in the analysis. About 45% of the pts received oral anticoagulation. This population had a higher STS Score (8.5±6.1% vs. 7.4±5.3%) and logEuroSCORE (20.0±13.9% vs. 18.0±11.7%, both p<0.05) whereas the age did not differ significantly (80.1±5.5 vs. 80.3±6.2 years, p>0.05). Overall VARC2 device success was achieved in 93.3 vs. 92.9% (p=n.s.). Significant valve thrombosis occurred in 0.4% in the anti-platelet group, but not in the OAC group. At one year follow-up, valve performance did not differ between the groups (Pmean 9.1±4.2 vs. 9.6±5.1mmHg, AVOA 2.1±0.4 vs. 1.9±0.5cm2, p>0.05). The occurrence of any access site complication was higher (27.0 vs. 22.6%, p=0.02), whereas bleeding complications (32.1% vs. 34.8%) and neurologic events were fewer (2.6% vs. 5.8%, p=0.03) with oral anticoagulation. However all-cause mortality was higher (16.2% vs. 10.2%, p=0.03), primarily driven by cardiovascular mortality. The treatment with new oral anticoagulants showed a mortality benefit (8.7%, p=0.04).
Pts with oral anticoagulation after TAVR do not necessarily experience more bleeding events but may be more protected against valve thrombosis and neurologic events thus the decisions for the optimal antithrombotic treatment after TAVR should be made with caution balancing individual bleeding and thromboembolic risk. Further randomized studies are ongoing to address this crucial topic.
STRUCTURAL: Valvular Disease: Aortic