Key result
Oral anticoagulation after TAVR is linked to ~40% higher mortality compared to antiplatelet monotherapy.
Why the study?
The optimal anticoagulant therapy after transcatheter aortic valve replacement remains a matter of debate.
Does the choice of antithrombotic regimen affect all-cause mortality in patients post-TAVR compared to antiplatelet monotherapy?
Cohort (n=4,812)
Does the choice of antithrombotic regimen affect all-cause mortality in patients post-TAVR compared to antiplatelet monotherapy?
Hazard Ratio: 3.95 (95% CI 2.95–5.27)
Absolute Event Rate: 44.8% vs 10.6%
p-value: p=<0.0001
Real-world data shows substantial deviation from guidelines in post-TAVR antithrombotic therapy, with OAC and no treatment associated with higher mortality compared to antiplatelet monotherapy.
High non-adherence to post-TAVR anticoagulation guidelines associates with increased mortality; leaves open optimal regimens for randomized confirmation.
Background: Transcatheter aortic valve replacement (TAVR) has developed to the therapy of choice for patients with symptomatic severe aortic stenosis who are unsuitable for surgical aortic valve replacement and elderly patients with intermediate or high operative risk. However, the optimal anticoagulant therapy post-TAVR still remains a matter of debate. Aims: This study sought to investigate current anticoagulant treatment patterns and clinical outcome in patients undergoing TAVR. Methods: In a retrospective study based on anonymized health claims data of approximately seven million Germans with statutory health insurance (InGef database), anticoagulant treatment regimens were assessed using any drug prescription post discharge within the first 90 days after TAVR procedure. Clinical events between 30 days and 6 months were examined by treatment regime. Results: The study population comprised 4,812 patients with TAVR between 2014 and 2018: 29.4% received antiplatelet monotherapy, 17.8% dual antiplatelet therapy, 17.4% oral anticoagulation (OAC) plus antiplatelet therapy, 12.9% OAC monotherapy, 2.2% triple therapy and 19.2% did not receive any anticoagulatory drugs. Sixty-four percentage of patients with OAC received direct oral anticoagulants (DOAC). Hence, 68% of all patients were treated non-adherent to current guidelines. Forty percentage of patients with OAC prior to TAVR did not have any OAC after TAVR. The adjusted risk of all-cause mortality was significantly increased in patients with OAC (HR 1.40, 95% CI 1.03–1.90, p = 0.03) and no anticoagulatory treatment (HR 3.95, 95% CI 2.95–5.27, p < 0.0001) when compared to antiplatelet monotherapy. Conclusions: This large real-world data analysis demonstrates substantial deviations from guideline recommendations and treatment after TAVR. Considering relevant differences in clinical outcome across treatment groups, major effort is warranted to examine underlying causes and improve guideline adherence.
No takes yet. Share an insight, caveat, or question.
Hohmann et al. (2021) conducted a cohort in Transcatheter Aortic Valve Replacement (TAVR) (n=4,812). No anticoagulatory treatment vs. Antiplatelet monotherapy was evaluated on All-cause mortality (HR 3.95, 95% CI 2.95-5.27, p=<0.0001). Compared to antiplatelet monotherapy, both oral anticoagulation (HR 1.40) and no anticoagulatory treatment (HR 3.95) after TAVR were associated with a significantly increased risk of all-cause mortality.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: