Comparison of Direct Oral Anticoagulants vs Vitamin K Antagonists After Transcatheter Mitral Valve Replacement

被引：6

作者：

El Beze, Nathan ^{[1
]}

Himbert, Dominique ^{[1
,2
]}

Suc, Gaspard ^{[1
,2
]}

Brochet, Eric ^{[1
]}

Ajzenberg, Nadine ^{[2
,3
]}

Cailliau, Audrey ^{[1
]}

Kikoine, John ^{[1
]}

Delhomme, Clemence ^{[1
]}

Carrasco, Jose Luis ^{[4
]}

Ou, Phalla ^{[5
]}

Iung, Bernard ^{[1
,2
]}

Urena, Marina ^{[1
,2
,6
]}

机构：

[1] Paris City Univ, Bichat Claude Bernard Hosp, Dept Cardiol, Paris, France

[2] INSERM, INSERM UMRS1148, Paris, France

[3] Paris City Univ, Bichat Claude Bernard Hosp, Dept Hematol, Paris, France

[4] Paris City Univ, Bichat Claude Bernard Hosp, Dept Anesthesiol, Paris, France

[5] Paris City Univ, Bichat Claude Bernard Hosp, Dept Radiol, Paris, France

[6] Dept Cardiol, 46 Rue Henri Huchard, F-75018 Paris, France

来源：

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY | 2024年 / 83卷 / 02期

关键词：

KEY WORDS anticoagulation; direct oral anticoagulant; TMVR; vitamin K antagonist; WARFARIN; RIVAROXABAN; MORTALITY;

D O I：

10.1016/j.jacc.2023.10.031

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

BACKGROUND There is currently no established recommendation for antithrombotic treatment following transcath-eter mitral valve replacement (TMVR). However, based on the analogy with surgical mitral bioprosthesis, vitamin K antagonists (VKAs) are predominantly used. OBJECTIVES The purpose of this study was to compare bleeding and thrombotic events associated with direct oral anticoagulants (DOACs) or VKAs in a prospective cohort of TMVR patients. METHODS We enrolled consecutive patients who underwent transseptal TMVR using a SAPIEN family prosthesis at our center between 2011 and 2023. The primary outcome was the occurrence of bleeding. VKAs were administered to pa-tients until October 2019, after which DOACs were prescribed. The median follow-up was 4.7 months (Q1-Q3: 2.6-6.7 months). RESULTS A total of 156 patients were included. The mean age was 65 +/- 18.5 years, and 103 patients (66%) were women. The median EuroSCORE II was 7.48% (Q1-Q3: 3.80%-12.97%). Of the participants, 20.5% received DOACs and 79.5% were treated with VKAs. The primary outcome was observed in 50 (40%) patients in the VKA group and 3 (9%) patients in the DOAC group (adjusted HR: 0.21; 95% CI: 0.06-0.74; P = 0.02). Treatment with DOAC was associated with a shorter length of hospital stay. No significant differences were found in terms of thrombotic events, major vascular complications, stroke, or death. CONCLUSIONS The use of DOACs after TMVR, compared with VKAs, appears to reduce the risk of bleeding compli-cations and decrease the length of hospital stay for patients, without a significant increase in the risk of thrombotic events. (J Am Coll Cardiol 2024;83:334-346) (c) 2024 by the American College of Cardiology Foundation.

引用

页码：334 / 346

页数：13

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