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Comparison of warfarin versus DOACs in patients with concomitant indication for oral anticoagulation undergoing TAVI; results from the ATLAS registry

  • Konstantinos Kalogeras
  • Richard J. Jabbour
  • Neil Ruparelia
  • Samuel Watson
  • Tito Kabir
  • Toru Naganuma
  • Manolis Vavuranakis
  • Sunao Nakamura
  • Iqbal S. Malik
  • Ghada Mikhail
  • Miles Dalby
  • Vasileios PanoulasEmail author
Article
  • 65 Downloads

Abstract

The optimal antithrombotic therapy for patients undergoing TAVI with concomitant indication for oral anticoagulation remains unclear. In this high-risk population group, there is a paucity of data with regards to the use of DOACs. In the present study we compared long-term clinical outcomes of TAVI patients requiring anticoagulation, treated with warfarin versus DOACs. Consecutive patients, who underwent TAVI with indication for oral anticoagulation from the multicenter ATLAS registry were studied and divided in two groups depending on the chosen anticoagulation regimen, warfarin vs. DOACs. 30-day survival, as well as estimated 1 and 2-year all-cause mortality were compared between groups. The secondary endpoint included in-hospital major or life-threatening bleeding. The study group included 217 patients (102 treated with warfarin; 115 treated with DOACs). Kaplan–Meier estimated survival was found to be statistically similar in the warfarin and DOAC groups (90.6% vs. 93.7% for 1-year and 84.5% vs. 88.5%, for 2-year survival, respectively, Plog-rank = 0.984). Adjusted hazard ratio for all cause mortality was similar between the two groups (HRwarfarin vs. DOAC = 1.15; 95% CI 0.33 to 4.04, p = 0.829). Propensity matching revealed similar results. At 30-days, all-cause mortality was found to be comparable between the two groups. With regards to BARC defined bleeding complications, major and life-threatening complications did not differ between the two anticoagulation groups (6% vs. 8% for warfarin and DOACs respectively, p = 0.857). DOACs seem to demonstrate a similar safety and efficacy profile compared to warfarin in TAVI patients with a concomitant indication for oral anticoagulation.

Keywords

TAVI Warfarin DOACs Survival Bleeding 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Konstantinos Kalogeras
    • 1
    • 2
  • Richard J. Jabbour
    • 3
    • 4
  • Neil Ruparelia
    • 3
    • 4
  • Samuel Watson
    • 1
  • Tito Kabir
    • 1
  • Toru Naganuma
    • 5
  • Manolis Vavuranakis
    • 2
    • 6
  • Sunao Nakamura
    • 5
  • Iqbal S. Malik
    • 3
    • 4
  • Ghada Mikhail
    • 3
    • 4
  • Miles Dalby
    • 1
    • 3
  • Vasileios Panoulas
    • 1
    • 3
    Email author
  1. 1.Department of Cardiology, Harefield HospitalRoyal Brompton and Harefield NHS Foundation TrustLondonUK
  2. 2.1st Department of Cardiology, Hippokration Hospital, Medical SchoolNational & Kapodistrian University of AthensAthensGreece
  3. 3.Cardiovascular Sciences, National Heart and Lung InstituteImperial College LondonLondonUK
  4. 4.Department of Cardiology, Hammersmith HospitalImperial College Healthcare NHS TrustLondonUK
  5. 5.Department of CardiologyNew Tokyo HospitalMatsudoJapan
  6. 6.3rd Department of Cardiology, Sotiria Hospital, Medical SchoolNational and Kapodistrian University of AthensAthensGreece

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