Lack of post-TAVR warfarin treatment was associated with a higher risk of transcatheter heart valve thrombosis compared to warfarin therapy (10.7% vs. 1.8%; RR 6.09; 95% CI 1.86-19.84).
Cohort (n=460)
Relative Risk: 6.09 (95% CI 1.86–19.84)
Absolute Event Rate: 10.7% vs 1.8%
BACKGROUND: There are limited data on the incidence, clinical implications, and predisposing factors of transcatheter heart valve (THV) thrombosis following transcatheter aortic valve replacement (TAVR). OBJECTIVES: The authors assessed the incidence, potential predictors, and clinical implications of THV thrombosis as determined by contrast-enhanced multidetector computed tomography (MDCT) after TAVR. METHODS: Among 460 consecutive patients who underwent TAVR with the Edwards Sapien XT or Sapien 3 (Edwards Lifesciences, Irvine, California) THV, 405 (88%) underwent MDCT in addition to transthoracic and transesophageal echocardiography 1 to 3 months post-TAVR. MDCT scans were evaluated for hypoattenuated leaflet thickening that indicated THV thrombosis. RESULTS: MDCT verified THV thrombosis in 28 of 405 (7%) patients. A total of 23 patients had subclinical THV thrombosis, whereas 5 (18%) patients experienced clinically overt obstructive THV thrombosis. THV thrombosis risk did not differ among different generations of THVs (8% vs. 6%; p = 0.42). The risk of THV thrombosis in patients who did not receive warfarin was higher compared with patients who received warfarin (10.7% vs. 1.8%; risk ratio RR: 6.09; 95% confidence interval CI: 1.86 to 19.84). A larger THV was associated with an increased risk of THV thrombosis (p = 0.03). In multivariable analysis, a 29-mm THV (RR: 2.89; 95% CI: 1.44 to 5.80) and no post-TAVR warfarin treatment (RR: 5.46; 95% CI: 1.68 to 17.7) independently predicted THV thrombosis. Treatment with warfarin effectively reverted THV thrombosis and normalized THV function in 85% of patients as documented by follow-up transesophageal echocardiography and MDCT. CONCLUSIONS: Incidence of THV thrombosis in this large study was 7%. A larger THV size may predispose to THV thrombosis, whereas treatment with warfarin appears to have a protective effect. Although often subclinical, THV thrombosis may have important clinical implications.
Hansson et al. (2016) conducted a cohort in Transcatheter aortic valve replacement (TAVR) (n=460). No post-TAVR warfarin treatment vs. Warfarin treatment was evaluated on Transcatheter heart valve (THV) thrombosis (RR 6.09, 95% CI 1.86-19.84). Lack of post-TAVR warfarin treatment was associated with a higher risk of transcatheter heart valve thrombosis compared to warfarin therapy (10.7% vs. 1.8%; RR 6.09; 95% CI 1.86-19.84).