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TAVR Patients Requiring Anticoagulation: Direct Oral Anticoagulant or Vitamin K Antagonist?

Romain Didier 1 Thibault Lhermusier 2 Vincent Auffret 3 Hélène Eltchaninoff 4, 5 Herve Le Breton 6 Guillaume Cayla 7 Philippe Commeau 8 J. P. Collet 9, 10, 11 Thomas Cuisset 12 Nicolas Dumonteil 13 J. P. Verhoye 14 Sylvain Beurtheret 15 Thierry Lefevre 16 Emmanuel Teiger 17 Didier Carrié 2 Dominique Himbert 18 Bernard Albat 19 Alain Cribier 20 Arnaud Sudre 21 Didier Blanchard 22 Olivier Bar 23 Gilles Rioufol 24 Frédéric Collet Remi Houel 15 Louis Labrousse 25 Nicolas Meneveau 26 Said Ghostine 27 Thibaut Manigold 28 Philippe Guyon 29 Stephane Delepine 30 Xavier Favereau 31 Geraud Souteyrand 32 Patrick Ohlmann 33 Vincent Doisy 34 Farzin Beygui 11 Antoine Gommeaux 35 Jean-Philippe Claudel 36 Francois Bourlon 37 Bernard Bertrand 38, 39 Bernard Iung 40 Martine Gilard 41
Abstract : OBJECTIVES: Using French transcatheter aortic valve replacement (TAVR) registries linked with the nationwide administrative databases, the study compared the rates of long-term mortality, bleeding, and ischemic events after TAVR in patients requiring oral anticoagulation with direct oral anticoagulants (DOACs) or vitamin K antagonists (VKAs). BACKGROUND: The choice of optimal drug for anticoagulation after TAVR remains debated. METHODS: Data from the France-TAVI and FRANCE-2 registries were linked to the French national health single-payer claims database, from 2010 to 2017. Propensity score matching was used to reduce treatment-selection bias. Two primary endpoints were death from any cause (efficacy) and major bleeding (safety). RESULTS: A total of 24,581 patients who underwent TAVR were included and 8,962 (36.4%) were treated with OAC. Among anticoagulated patients, 2,180 (24.3%) were on DOACs. After propensity matching, at 3 years, mortality (hazard ratio [HR]: 1.37; 95% confidence interval [CI]: 1.12-1.67; P \textless 0.005) and major bleeding including hemorrhagic stroke (HR: 1.64; 95% CI: 1.17-2.29; P \textless 0.005) were lower in patients on DOACs compared with those on VKAs. The rates of ischemic stroke (HR: 1.32; 95% CI: 0.81-2.15; P = 0.27) and acute coronary syndrome (HR: 1.17; 95% CI: 0.68-1.99; P = 0.57) did not differ among groups. CONCLUSIONS: In these large multicenter French TAVR registries with an exhaustive clinical follow-up, the long-term mortality and major bleeding were lower with DOACs than VKAs at discharge. The present study supports preferential use of DOACs rather than VKAs in patients requiring oral anticoagulation therapy after TAVR.
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Submitted on : Friday, November 26, 2021 - 6:01:33 PM
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Romain Didier, Thibault Lhermusier, Vincent Auffret, Hélène Eltchaninoff, Herve Le Breton, et al.. TAVR Patients Requiring Anticoagulation: Direct Oral Anticoagulant or Vitamin K Antagonist?. JACC: Cardiovascular Interventions, Elsevier/American College of Cardiology, 2021, 14 (15), pp.1704-1713. ⟨10.1016/j.jcin.2021.05.025⟩. ⟨inserm-03452171⟩

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