VKA monotherapy in AF patients undergoing TAVI significantly reduced death, stroke, embolism, and major bleeding compared to VKA plus SAPT (6.5% vs 22.0%, p=0.02) or DAPT (28.6%, p=0.002).
Cohort (n=167)
Does vitamin K antagonist monotherapy reduce bleeding and composite adverse events compared to VKA plus antiplatelet therapy in atrial fibrillation patients undergoing TAVI?
In patients with atrial fibrillation undergoing TAVI, VKA monotherapy is associated with significantly lower rates of major bleeding and composite adverse clinical events compared to VKA combined with single or dual antiplatelet therapy.
Absolute Event Rate: 6.5% vs 22%
p-value: p=0.02
AIMS: We aimed to assess the efficacy and safety of vitamin K antagonist (VKA) monotherapy in atrial fibrillation (AF) patients undergoing transcatheter aortic valve implantation (TAVI). METHODS AND RESULTS: In 735 TAVIs since 2008 we identified 167 patients suffering from concomitant AF who received either VKA monotherapy (n=77), VKA plus single antiplatelet therapy (SAPT, n=41) or a triple anticoagulation regimen (n=49). Thromboembolic as well as bleeding complications were analysed for six months after TAVI. Only one minor bleeding and no thromboembolic events occurred after VKA therapy had been initiated post TAVI. Compared to patients being treated with additional either single or dual antiplatelet therapy, the incidence of major/life-threatening bleeding complications was significantly lower in the VKA mono group (0/77 VKA mono vs. 3/41 VKA+SAPT; p=0.04 vs. 4/49 triple anticoagulation; p=0.02). Analysis of a combined endpoint of post-procedural death, stroke, embolism and major bleeding revealed a significant superiority of VKA monotherapy compared to VKA plus SAPT or DAPT, respectively (5/77 vs. 9/41 p=0.02 vs. 14/49 p=0.002). CONCLUSIONS: VKA therapy without additional antiplatelet treatment is effective and safe in AF patients undergoing TAVI.
Geis et al. (Sat,) conducted a cohort in Atrial fibrillation in patients undergoing transcatheter aortic valve implantation (n=167). Vitamin K antagonist (VKA) monotherapy vs. VKA plus single antiplatelet therapy (SAPT) or triple anticoagulation regimen was evaluated on Combined endpoint of post-procedural death, stroke, embolism and major bleeding (p=0.02). VKA monotherapy in AF patients undergoing TAVI significantly reduced death, stroke, embolism, and major bleeding compared to VKA plus SAPT (6.5% vs 22.0%, p=0.02) or DAPT (28.6%, p=0.002).
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