Is There Variation in Antithrombotic Therapy For AFib Patients Undergoing TAVR?

Discharge medication patterns may vary significantly for patients with atrial fibrillation (AFib) who undergo TAVR, including "significant underuse" of oral anticoagulants (OACs), according to a study published April 20 in Circulation: Cardiovascular Interventions.

Matthew W. Sherwood, MD, MHS, FACC, et al., used data from the STS/ACC TVT Registry to evaluate differences in care and the role of antithrombotic therapies for patients who underwent TAVR with concomitant AFib from November 2011 to September 2015 in the U.S. Each patient was examined based on whether they received antiplatelet therapies (APTs), OACs or both at discharge. The researchers also used inverse probability weighting and multivariable regression modeling to assess the relation between antithrombotic therapies and one-year health outcomes of stroke, bleeding and mortality.

Results showed that of the 11,382 patients examined, 51.2% received both OAC and APT, 42% received only APT, and 6.7% had OAC alone at discharge. A total of 42% of patients were discharged without OAC therapy. The authors note that in adjusted analyses, there was no difference in the risk of stroke and mortality between the three antithrombotic strategies. However, patients who received both OAC and APT had a significantly higher risk of bleeding than patients who had APT or OAC therapy alone.

"We found substantial heterogeneity in prescription patterns of different antithrombotic regimens at discharge, highlighting the lack of consensus on optimal therapy for this population," the authors conclude.

In a related editorial comment, Mirvat A. Alasnag, MD, FACC, et al., adds that "an important lesson learned from the TAVR experience is that leaps in the technology should have parallel progress in antithrombotic management. The current gap in evidence and guidelines explains the wide variation of practice reported by Sherwood, et al."

Clinical Topics: Anticoagulation Management, Arrhythmias and Clinical EP, Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Anticoagulation Management and Atrial Fibrillation, Atrial Fibrillation/Supraventricular Arrhythmias, Cardiac Surgery and Arrhythmias

Keywords: Transcatheter Aortic Valve Replacement, Registries, National Cardiovascular Data Registries, STS/ACC TVT Registry, Fibrinolytic Agents, Atrial Fibrillation, Patient Discharge, Kanamycin Kinase, Dimaprit, Anticoagulants, Stroke, Hemorrhage, Prescriptions, Outcome Assessment (Health Care)

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