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February 13, 2018HeartOpen Access

The incidence of valve haemodynamic deterioration was significantly lower in the anticoagulation group compared with the non-anticoagulation group in the propensity-matched populations (0.6% vs 3.9%, P<0.001).

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Why the study?

Does anticoagulation therapy prevent valve haemodynamic deterioration in patients following transcatheter aortic valve replacement?

Population

2466 patients who underwent transcatheter aortic valve replacement with echocardiography performed at…

Comparison

Anticoagulation therapy following TAVR vs No anticoagulation therapy following TAVR

Design

Cohort

Follow-up

Mean clinical follow-up 29±18 months; echocardiography at…

Authors

MTMaría Del TrigoAMAntonio J. Muñoz-GarcíaALAzeem Latib

Discussion

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Overview

Anticoagulation post-TAVR was associated with lower valve deterioration; leaves open causality and optimal use pending randomized trials.

Key Points

  • To evaluate the relationship between post-procedure anticoagulation therapy and changes in transvalvular gradients or the incidence of valve haemodynamic deterioration following transcatheter aortic valve replacement.
  • Multicentre study of 2466 patients (46% men; mean age 81±7 years) who underwent transcatheter aortic valve replacement with echocardiography at 12-month follow-up (mean clinical follow-up 29±18 months).
  • Anticoagulation therapy was administered to 707 patients (28.7%; 663 receiving vitamin K antagonists and 44 receiving direct oral anticoagulants), with 622 patients per group analyzed using propensity score matching.
  • Valve haemodynamic deterioration was defined as an increase of ≥10 mm Hg in the mean transprosthetic gradient between hospital discharge and follow-up.
  • In the overall cohort, mean transvalvular gradient increased significantly in the non-anticoagulation group (P=0.003) but remained stable in the anticoagulation group (P=0.323).
  • Valve haemodynamic deterioration occurred in 0.6% of the anticoagulation group versus 3.7% of the non-anticoagulation group (P<0.001), remaining lower in matched cohorts (0.6% vs 3.9%, P<0.001).
  • Valve haemodynamic deterioration was not associated with all-cause death (P=0.468), cardiovascular death (P=0.539), or stroke (P=0.170) during follow-up.

Structured PICO

Does anticoagulation therapy prevent valve haemodynamic deterioration in patients following transcatheter aortic valve replacement?

P
Population
2466 patients who underwent transcatheter aortic valve replacement (TAVR) with echocardiography performed at 12-month follow-up, mean age 81±7 years, 46% men.
I
Intervention
Anticoagulation therapy (vitamin K antagonists or direct oral anticoagulants) following TAVR
C
Comparator
No anticoagulation therapy following TAVR
O
Outcome
Changes in transvalvular gradients and incidence of valve haemodynamic deterioration (VHD) defined as a ≥10 mm Hg increase in the mean transprosthetic gradient at follow-up (vs hospital discharge)surrogate

Anticoagulation therapy post-TAVR is associated with a significantly lower risk of subclinical valve haemodynamic deterioration compared to no anticoagulation.

Cite This Study

Trigo et al. (2018) studied this question.

synapsesocial.com/papers/6a8091a88ae067bd3b703e8bhttps://doi.org/10.1136/heartjnl-2017-312514
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Antithrombotic Therapy Selection and Association With Clinical Outcomes Following Valve‐in‐Valve Transcatheter Aortic Valve Replacement2025
  2. 2Heartbeat: Focus on valvular heart disease2018
  3. 3Long-Term Mortality and Early Valve Dysfunction According to Anticoagulation Use2018 · 114 citations
  4. 4Predictors of haemodynamic structural valve deterioration following transcatheter aortic valve implantation with latest-generation balloon-expandable valves2020 · 30 citations
  5. 5Impact of Anticoagulation on Valve Hemodynamics Following Transcatheter Valve-In-Valve Implantation2026