NOAC monotherapy in patients with concomitant indications for oral anticoagulation undergoing transcatheter aortic valve implantation

  • Nicolas A. Geis
  • Christina Kiriakou
  • Emmanuel Chorianopoulos
  • Lorenz Uhlmann
  • Hugo A. Katus
  • Raffi Bekeredjian
Original Paper
  • 19 Downloads

Abstract

Aims

Antithrombotic therapy after transcatheter aortic valve implantation (TAVI) is highly controversial and guideline recommendations are not evidence based. We assessed efficacy and safety of non-vitamin K antagonist oral anticoagulant (NOAC) monotherapy in patients with concomitant indications for OAC undergoing TAVI.

Methods

Among more than 1300 TAVI patients since 2008, 154 patients were identified who received postinterventional NOAC monotherapy. Outcomes were compared to 172 patients treated with vitamin K antagonist (VKA) monotherapy. Thromboembolic as well as bleeding complications were analysed for 6 months after TAVI.

Results

Despite high CHA2DS2-Vasc (4.6 ± 1.2), HEMORR2HAGES (4.7 ± 1.9) and HASBLED (2.7 ± 0.8) scores only three major/life-threatening bleedings and four thromboembolic events occurred after NOAC therapy had been initiated post-TAVI. 12 patients (7.8%) died within 6 months after the procedure. Compared to patients being treated with VKA monotherapy, analysis of a combined end-point of post-procedural death, stroke, embolism and severe bleeding revealed no significant differences (17/154 vs. 14/172; p = 0.45).

Conclusions

The results of this study suggest that NOAC therapy without additional antiplatelet treatment is effective and safe in patients with concomitant indications for OAC undergoing TAVI.

Keywords

Transcatheter aortic valve replacement Transcatheter aortic valve implantation Atrial fibrillation NOAC Anticoagulation Antithrombotic therapy 

Abbreviations

AF

Atrial fibrillation

DAPT

Dual antiplatelet therapy

HALT

Hypo-attenuated leaflet thickening

ICB

Intracranial bleeding

LMWH

Low molecular weight heparin

MPG

Mean pressure gradient

NOAC

Non-vitamin K antagonist oral anticoagulant

OAC

Oral anticoagulation

PTT

Partial thromboplastin time

SAPT

Single antiplatelet therapy

SAVR

Surgical aortic valve replacement

TAVI

Transcatheter aortic valve implantation

TIA

Transitory ischaemic attack

VKA

Vitamin K antagonist

Notes

Compliance with ethical standards

Conflict of interest

Nicolas A. Geis, Raffi Bekeredjian and Emmanuel Chorianopoulos are investigators in the ADVANCE II and SIMPLIFy TAVI trial. The other authors report no conflicts of interest regarding the content herein.

Ethical standards

All patients were informed about indication, specific risks and alternatives of TAVI and gave informed written consent to the procedure and pre- and post-interventional monitoring (data collection). The study protocol has been approved by the local ethics committee and has, therefore, been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Nicolas A. Geis
    • 1
  • Christina Kiriakou
    • 1
  • Emmanuel Chorianopoulos
    • 1
  • Lorenz Uhlmann
    • 2
  • Hugo A. Katus
    • 1
  • Raffi Bekeredjian
    • 1
  1. 1.Department of Internal Medicine IIIUniversity of HeidelbergHeidelbergGermany
  2. 2.Institute of Medical Biometry and InformaticsUniversity of HeidelbergHeidelbergGermany

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