Clinical Research in Cardiology

, Volume 107, Issue 9, pp 799–806 | Cite as

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



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.


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



Atrial fibrillation


Dual antiplatelet therapy


Hypo-attenuated leaflet thickening


Intracranial bleeding


Low molecular weight heparin


Mean pressure gradient


Non-vitamin K antagonist oral anticoagulant


Oral anticoagulation


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.

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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