NOAC monotherapy in patients with concomitant indications for oral anticoagulation undergoing transcatheter aortic valve implantation
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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.
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.
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).
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.
KeywordsTranscatheter aortic valve replacement Transcatheter aortic valve implantation Atrial fibrillation NOAC Anticoagulation Antithrombotic therapy
Dual antiplatelet therapy
Hypo-attenuated leaflet thickening
Low molecular weight heparin
Mean pressure gradient
Non-vitamin K antagonist oral anticoagulant
Partial thromboplastin time
Single antiplatelet therapy
Surgical aortic valve replacement
Transcatheter aortic valve implantation
Transitory ischaemic attack
Vitamin K antagonist
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.
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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