Safety and Efficacy of Transcatheter Aortic Valve Replacement With Continuation of Vitamin K Antagonists or Direct Oral Anticoagulants

被引：30

作者：

Brinkert, Miriam ^{[1
]}

Mangner, Norman ^{[2
]}

Moriyama, Noriaki ^{[3
]}

Keller, Lukas S. ^{[4
]}

Hagemeyer, Daniel ^{[5
]}

Crusius, Lisa ^{[2
]}

Lehnick, Dirk ^{[6
]}

Kobza, Richard ^{[1
]}

Abdel-Wahab, Mohamed ^{[7
,8
]}

Laine, Mika ^{[3
]}

Stortecky, Stefan ^{[5
]}

Pilgrim, Thomas ^{[5
]}

Nietlispach, Fabian ^{[4
,9
]}

Ruschitzka, Frank ^{[4
]}

Thiele, Holger ^{[7
,8
]}

Linke, Axel ^{[2
]}

Toggweiler, Stefan ^{[1
]}

机构：

[1] Luzerner Kantonsspital, Heart Ctr Lucerne, Luzern, Switzerland

[2] Tech Univ Dresden, Heart Ctr Dresden, Dept Internal Med & Cardiol, Dresden, Germany

[3] Helsinki Univ Cent Hosp, Div Cardiol, Helsinki, Finland

[4] Univ Hosp Zurich, Dept Cardiol, Zurich, Switzerland

[5] Univ Hosp Bern, Dept Cardiol, Bern, Switzerland

[6] Univ Lucerne, Clin Trial Unit, Biostat & Methodol, Luzern, Switzerland

[7] Univ Leipzig, Dept Internal Med Cardiol, Heart Ctr Leipzig, Leipzig, Germany

[8] Leipzig Heart Inst, Dept Internal Med Cardiol, Leipzig, Germany

[9] Hirslanden Clin Pk, CardioVasc Ctr Zurich, Zurich, Switzerland

来源：

JACC-CARDIOVASCULAR INTERVENTIONS | 2021年 / 14卷 / 02期

关键词：

aortic stenosis; bleeding; direct oral anticoagulant; oral anticoagulation; CLINICAL-OUTCOMES; RISK-FACTORS; IMPLANTATION; STROKE; TAVI; PREDICTORS; COREVALVE; STENOSIS; COMPLICATIONS; METAANALYSIS;

D O I：

10.1016/j.jcin.2020.09.062

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

OBJECTIVES This study investigated whether transcatheter aortic valve replacement (TAVR) with peri-procedural continuation of oral anticoagulation is equally safe and efficacious as TAVRwith peri-procedural interruption of anticoagulation. BACKGROUND A significant proportion of patients undergoing TAVR have an indication for long-term oral anticoagulation. The optimal peri-procedural management of such patients is unknown. METHODS Consecutive patients on oral anticoagulation who underwent transfemoral TAVR at 5 European centers were enrolled. Oral anticoagulation was either stopped 2 to 4 days before TAVR or continued throughout the procedure. Primary safety outcome was major bleeding. Secondary efficacy endpoints included vascular complications, stroke, and mortality. RESULTS Of 4,459 patients, 584 patients were treated with continuation of anticoagulation and 733 with interruption of anticoagulation. At 30 days, major or life-threatening bleedings occurred in 66 (11.3%) versus 105 (14.3%; odds ratio [OR]: 0.86; 95% confidence interval [CI]: 0.61 to 1.21; p = 0.39) and major vascular complications in 64 (11.0%) versus 90 (12.3%; OR: 0.89; CI: 0.62 to 1.27; p = 0.52) of patients with continuation and with interruption of anticoagulation, respectively. Transfusion of packed red blood cells was less often required in patients with continuation of anticoagulation (80 [13.7%] vs. 130 [17.7%]; OR: 0.59; 95% CI: 0.42 to 0.81; p = 0.001). Kaplan-Meier estimates of survival at 12 months were 85.3% in patients with continuation of anticoagulation and 84.0% in patients with interruption of anticoagulation (hazard ratio: 0.90; 95% CI: 0.73 to 1.12; p = 0.36). CONCLUSIONS Continuation of oral anticoagulation throughout TAVR did not increase bleeding or vascular complication rates. Moreover, packed red blood cell transfusions were less often required in patients with continuation of oral anticoagulation. (J Am Coll Cardiol Intv 2021;14:135-44) (c) 2021 by the American College of Cardiology Foundation.

引用

页码：135 / 144

页数：10