Why the study?
Do novel oral anticoagulants (NOACs) improve outcomes or safety compared to vitamin K antagonists (VKAs) in patients with atrial fibrillation after transcatheter aortic valve replacement (TAVR)?
Do novel oral anticoagulants (NOACs) improve outcomes or safety compared to vitamin K antagonists (VKAs) in patients with atrial fibrillation after transcatheter aortic valve replacement (TAVR)?
In patients with atrial fibrillation undergoing TAVR, NOACs do not offer significantly different outcomes or a superior safety profile compared to VKAs, leaving the choice of anticoagulant to clinical judgment.
Anticoagulant selection after TAVR in AF remains at clinician discretion; leaves open whether dedicated RCTs will identify a preferred agent.
Key Points Current meta‐analysis suggests that outcomes with novel oral anticoagulants (NOACs) do not significantly differ compared to vitamin K antagonists (VKAs) after transcatheter aortic valve replacement (TAVR) in patients with atrial fibrillation (AF), in particular, NOACs failed to demonstrate a better safety profile than VKAs in this clinical setting. Accordingly, the choice between NOACs and VKAs in AF patients after TAVR is left to clinical judgment. Future large‐scale clinical trials are warranted to establish a clinically superior anticoagulant regime in this clinical setting, based on risk profile and need for concomitant antiplatelet therapy.
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Tarantini et al. (2022) studied this question.
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