Anticoagulation Therapy for Atrial Fibrillation After Transcatheter Aortic Valve Replacement: National Database Insights

Background Transcatheter aortic valve replacement (TAVR) is increasingly used in patients with aortic stenosis; however, the optimal postoperative anticoagulation therapy for patients with atrial fibrillation (AF) remains controversial. We aimed to investigate the association between anticoagulant therapy selection and outcomes in patients with AF after TAVR.Methods We retrospectively analyzed patients with AF who underwent TAVR. Patients were divided into 2 groups according to the anticoagulant therapy administered 3 months after the index TAVR (direct oral anticoagulant [DOAC] and vitamin K antagonist [VKA] groups). The primary end points were thromboembolic and major bleeding events after a landmark period of 3 months. We analyzed the association between oral anticoagulants and outcomes using propensity score matching.Results Among 47 883 patients who underwent TAVR between April 2014 and March 2021, 10 041 had a history of AF and anticoagulant therapy. Of these, 8191 patients were prescribed a DOAC, while 1850 received a VKA. Before matching, the thromboembolic event rate was 2.2 per 100 person-years in the DOAC group and 3.6 per 100 person-years in the VKA group, whereas the bleeding event rates were 7.1 and 10.0 per 100 person-years, respectively. After matching, VKA was associated with higher risks of thromboembolic events (hazard ratio [HR], 1.46 [95% CI, 1.12-1.91]; P=0.004) and bleeding events (HR, 1.21 [95% CI, 1.03-1.42]; P=0.016).Conclusions DOAC use in patients with AF who undergo TAVR may be preferable to VKA use in a real-world clinical setting.