Log in to MyACC
Anticoagulation After Transcatheter Mitral Valve Replacement
Quick Takes
- In patients undergoing transcatheter mitral valve replacement (TMVR), the use of DOACs was associated with a lower incidence of bleeding complications than treatment with VKAs, with no significant differences in the risk of thrombotic events.
- Furthermore, the use of DOACs was associated with a shorter length of hospital stay compared with VKAs.
- Large randomized trials are needed to confirm these findings and guide selection of the optimum antithrombotic treatment strategy for patients undergoing TMVR.
Study Questions:
What are the bleeding and thrombotic events associated with direct oral anticoagulants (DOACs) or vitamin K antagonists (VKAs) in a prospective cohort of patients who underwent transcatheter mitral valve replacement (TMVR)?
Methods:
The investigators enrolled consecutive patients who underwent transseptal TMVR using a SAPIEN family prosthesis at their center between 2011 and 2023. The primary outcome was the occurrence of bleeding. The secondary outcomes were thrombotic complications (valve thrombosis or stroke), death, major vascular complications, and the length of stay. VKAs were administered to patients until October 2019, after which DOACs were prescribed. The median follow-up was 4.7 months (Q1-Q3: 2.6-6.7 months). Censored variables were evaluated using Kaplan-Meier estimates, and survival curves were compared using log-rank tests. Univariate and multivariable Cox regression models were utilized to assess the association between covariates and censored outcomes.
Results:
A total of 156 patients were included. The mean age was 65 ± 18.5 years, and 103 patients (66%) were women. The median EuroSCORE II was 7.48% (Q1-Q3: 3.80%-12.97%). Of the participants, 20.5% received DOACs and 79.5% were treated with VKAs. The primary outcome was observed in 50 (40%) patients in the VKA group and 3 (9%) patients in the DOAC group (adjusted hazard ratio, 0.21; 95% confidence interval, 0.06-0.74; p = 0.02). Treatment with DOAC was associated with a shorter length of hospital stay. No significant differences were found in terms of thrombotic events, major vascular complications, stroke, or death.
Conclusions:
The authors report that the use of DOACs after TMVR, compared with VKAs, appears to reduce the risk of bleeding complications and decrease the length of hospital stay for patients, without a significant increase in the risk of thrombotic events.
Perspective:
This single-center study reports that in patients undergoing TMVR, the use of DOACs was associated with a lower incidence of bleeding complications than treatment with VKAs, particularly early bleeding events. with no significant differences in the risk of thrombotic events, including valve thrombosis, between DOACs and VKAs. Furthermore, the use of DOACs was associated with a shorter length of hospital stay compared with VKAs. Given the single-center observational nature of the study, these findings should be considered as hypothesis generating and large randomized trials are needed to confirm these findings and guide selection of the optimum antithrombotic treatment strategy for patients undergoing TMVR.
Clinical Topics: Anticoagulation Management, Valvular Heart Disease, Cardiac Surgery and VHD, Invasive Cardiovascular Angiography and Intervention
Keywords: Anticoagulants, Heart Valve Diseases, Thrombosis
< Back to Listings
