TAVR Patients Requiring Anticoagulation Direct Oral Anticoagulant or Vitamin K Antagonist?

被引：45

作者：

Didier, Romain ^{[1
]}

Lhermusier, Thibault ^{[2
]}

Auffret, Vincent ^{[3
]}

Eltchaninoff, Helene ^{[4
]}

Le Breton, Herve ^{[3
]}

Cayla, Guillaume ^{[5
]}

Commeau, Philippe ^{[6
]}

Collet, Jean Philippe ^{[7
]}

Cuisset, Thomas ^{[8
]}

Dumonteil, Nicolas ^{[9
]}

Verhoye, Jean Philippe ^{[3
]}

Beurtheret, Sylvain ^{[10
]}

Lefevre, Thierry ^{[11
]}

Teiger, Emmanuel ^{[12
]}

Carrie, Didier ^{[2
]}

Himbert, Dominique ^{[13
]}

Albat, Bernard ^{[14
]}

Cribier, Alain ^{[4
]}

Sudre, Arnaud ^{[15
]}

Blanchard, Didier ^{[16
]}

Bar, Olivier ^{[17
]}

Rioufol, Gilles ^{[9
]}

Collet, Frederic ^{[18
]}

Houel, Remi ^{[10
]}

Labrousse, Louis ^{[19
]}

Meneveau, Nicolas ^{[20
]}

Ghostine, Said ^{[21
]}

Manigold, Thibaut ^{[22
]}

Guyon, Philippe ^{[23
]}

Delepine, Stephane ^{[24
]}

Favereau, Xavier ^{[25
]}

Souteyrand, Geraud ^{[26
]}

Ohlmann, Patrick ^{[27
]}

Doisy, Vincent ^{[28
]}

Beygui, Farzin ^{[29
]}

Gommeaux, Antoine ^{[30
]}

Claudel, Jean-Philippe ^{[31
]}

Bourlon, Francois ^{[32
]}

Bertrand, Bernard ^{[33
]}

Iung, Bernard ^{[13
]}

Gilard, Martine ^{[14
]}

机构：

[1] Brest Univ Hosp, Dept Cardiol, Brest, France

[2] Toulouse Univ Hosp, Toulouse, France

[3] Rennes Univ Hosp, Rennes, France

[4] Rouen Univ Hosp, Rouen, France

[5] Nimes Univ Hosp, Nimes, France

[6] Polyclin Fleurs, Ollioules, France

[7] Hop La Pitie Salpetriere, AP HP, Paris, France

[8] Univ Hosp Marseille, La Timone, France

[9] Clin Pasteur, Toulouse, France

[10] St Joseph Hosp, Marseille, France

[11] Cardiovasc Inst Paris Sud, Paris, France

[12] Univ Hosp Henri Mondor, AP HP, Paris, France

[13] Univ Paris, Bichat Hosp, AP HP, Paris, France

[14] Univ Hosp Montpellier, Montpellier, France

[15] Univ Hosp Lille, Lille, France

[16] Univ Hosp Paris Ouest, AP HP, Paris, France

[17] Clin St Gatien, Tours, France

[18] Mediterranean Inst Cardiol, Marseille, France

[19] Univ Hosp Bordeaux, Bordeaux, France

[20] Besancon Univ Hosp, Besancon, France

[21] Hosp Marie Lannelongue, Le Plessis Robinson, France

[22] Univ Nantes, Dept Cardiol, St Herblain, France

[23] North Cardiol Ctr, St Denis, France

[24] Angers Univ Hosp, Angers, France

[25] Private Hosp Parly II, Le Chesnay, France

[26] Univ Hosp Clermont Ferrand, Clermont Ferrand, France

[27] Strasbourg Univ Hosp, Strasbourg, France

[28] Medipole Lyon Villeurbanne, Villeurbanne, France

[29] Caen Univ Hosp, Caen, France

[30] Private Hosp Bois Bernard, Henin Beaumont, France

[31] Clin Infirmerie Protestante Lyon, Lyon, France

[32] Monaco Cardiothorac Ctr, Monaco, Monaco

[33] Grenoble Alpes Univ Hosp, Dept Cardiol, Grenoble, France

来源：

JACC-CARDIOVASCULAR INTERVENTIONS | 2021年 / 14卷 / 15期

关键词：

antithrombotic treatment; transcatheter aortic valve replacement; anticoagulant; AORTIC-VALVE IMPLANTATION; ATRIAL-FIBRILLATION; TRANSCATHETER; REPLACEMENT; OUTCOMES; REGISTRY;

D O I：

10.1016/j.jcin.2021.05.025

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

OBJECTIVES Using French transcatheter aortic valve replacement (TAVR) registries linked with the nationwide administrative databases, the study compared the rates of long-term mortality, bleeding, and ischemic events after TAVR in patients requiring oral anticoagulation with direct oral anticoagulants (DOACs) or vitamin K antagonists (VKAs). BACKGROUND The choice of optimal drug for anticoagulation after TAVR remains debated. METHODS Data from the France-TAVI and FRANCE-2 registries were linked to the French national health single-payer claims database, from 2010 to 2017. Propensity score matching was used to reduce treatment-selection bias. Two pri-mary endpoints were death from any cause (efficacy) and major bleeding (safety). RESULTS A total of 24,581 patients who underwent TAVR were included and 8,962 (36.4%) were treated with OAC. Among anticoagulated patients, 2,180 (24.3%) were on DOACs. After propensity matching, at 3 years, mortality (hazard ratio [HR]: 1.37; 95% confidence interval [CI]: 1.12-1.67; P < 0.005) and major bleeding including hemorrhagic stroke (HR: 1.64; 95% CI: 1.17-2.29; P < 0.005) were lower in patients on DOACs compared with those on VKAs. The rates of ischemic stroke (HR: 1.32; 95% CI: 0.81-2.15; P = 0.27) and acute coronary syndrome (HR: 1.17; 95% CI: 0.68-1.99; P = 0.57) did not differ among groups. CONCLUSIONS In these large multicenter French TAVR registries with an exhaustive clinical follow-up, the long-term mortality and major bleeding were lower with DOACs than VKAs at discharge. The present study supports preferential use of DOACs rather than VKAs in patients requiring oral anticoagulation therapy after TAVR. (J Am Coll Cardiol Intv 2021;14:1704-13) (c) 2021 Published by Elsevier on behalf of the American College of Cardiology Foundation.

引用

页码：1704 / 1713

页数：10

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