Use of direct oral anticoagulants (DOACs) as opposed to warfarin after TAVR exhibited a lower risk of bleeding requiring hospitalization, all-cause mortality and stroke at one-year, according to a recent study published in American Heart Journal.

Using data from the STS/ACC TVT Registry linked with claims data from the Centers for Medicare and Medicaid Services, Tomo Ando, MD, et al., incorporated 29,142 patients who underwent TAVR between January 2013 and May 2018 and were discharged on an oral anticoagulant with 38% of patients on a DOAC. Use of DOACs increased over the five-year study period.

The study's primary outcome was bleeding requiring hospitalization at one year. Over the course of the study, 12% of patients on DOACs had bleeding requiring hospitalization vs. 15% of patients on warfarin (p<0.001). DOACs were associated with a significantly lower risk of bleeding requiring hospitalization when compared to warfarin (adjusted hazard ratio 0.49, 95% CI 0.43-0.56, p<0.001).

The authors also investigated all-cause mortality and stroke as two secondary outcomes of interest. Incidence of all-cause mortality was significantly less among patients on DOACs compared to those on warfarin (15.5% vs. 17.5%, p<0.001), while there was no statistically significant difference in incidence of stroke (2.47% vs. 2.39%, p=0.64). Lower risk among the DOAC group was also noted for both all-cause mortality (adjusted hazard ratio 0.61, 95% CI 0.57-0.66, p<0.001) and stroke (adjusted hazard ratio 0.86, 95% CI 0.81-0.92, p<0.001).

"Our study is important because TAVR patients are mostly elderly and usually at high risk for both bleeding and thromboembolic events and therefore more often excluded or underrepresented from randomized controlled trials or observational studies comparing DOACs and warfarin," write the authors.