In patients undergoing transcatheter edge-to-edge mitral valve repair, OAC monotherapy was associated with a decreased risk of all-cause mortality (HR 0.6; 95% CI 0.5-0.9; p=0.04).
Cohort (n=609)
Yes
Does OAC monotherapy improve long-term outcomes compared to other antithrombotic regimens in patients undergoing TEER with an indication for OAC?
In patients undergoing TEER who have an indication for oral anticoagulation, OAC monotherapy is associated with a lower risk of long-term all-cause mortality compared to regimens adding antiplatelet therapy.
Hazard Ratio: 0.6 (95% CI 0.5–0.9)
p-value: p=0.04
Transcatheter edge-to-edge mitral valve repair (TEER) has become established as a safe and efficacious therapy for severe mitral regurgitation (MR) in high-risk patients. Despite its widespread use, postprocedural antithrombotic therapy (ATT) still to date is based on local expertise rather than evidence. In a multicenter, observational cohort study, 646 consecutive patients undergoing TEER were enrolled; 609 patients were successfully treated and antithrombotic therapy analyzed; 449 patients (73.7%) were previously treated with oral anticoagulants (OAC) due to the high prevalence of atrial fibrillation (459/609, 75.4%). Postprocedural ATT in patients previously treated with OAC consisted of no additional, additional single (SAPT) or dual antiplatelet therapy (DAPT) in 146/449 (33.6%), 248/449 (55.2%) and 55/449 (12.2%), respectively. There were 234/449 (52.1%) patients treated with vitamin-k antagonists (VKA) and 215/449 (47.9%) with nonvitamin-k antagonist oral anticoagulants (NOAC). One hundred sixty patients (26.3%) had no prior indication for OAC and were predominantly treated with DAPT (132/160, 82.5%). Use of SAPT (17/160, 10.6%) and no APT (11/160, 6.9%) was marginal. No statistically significant differences in terms of in-hospital mortality or the rate of major adverse cardiac and cerebrovascular events (MACCE) between the different antithrombotic therapy regimens were observed. Multiple Cox regression analysis showed a statistically significant decreased risk for all-cause mortality after a median follow-up of 419 days for OAC monotherapy (HR 0.6, 95%-CI 0.5–0.9, p = 0.04). This study provides evidence for a more favorable long-term outcome of OAC monotherapy in patients with an indication for OAC and reiterates the urgent need for randomized controlled trials on the optimal antithrombotic treatment of TEER patients.
Waechter et al. (Tue,) conducted a cohort in Severe mitral regurgitation (n=609). Oral anticoagulant (OAC) monotherapy vs. OAC plus single or dual antiplatelet therapy was evaluated on All-cause mortality (HR 0.6, 95% CI 0.5-0.9, p=0.04). In patients undergoing transcatheter edge-to-edge mitral valve repair, OAC monotherapy was associated with a decreased risk of all-cause mortality (HR 0.6; 95% CI 0.5-0.9; p=0.04).
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