Valvular & structural heart disease
Clinical outcomes of direct oral anticoagulant versus warfarin after transcatheter aortic valve replacement: From the STS/ACC Transcatheter Valve Therapy (TVT) registry
Main finding · Any bleeding requiring hospitalizationResult — go to the resultAdjusted hazard ratio 0.49 95% CI 0.43–0.56Authors' conclusion
In this analysis of TAVR recipients discharged on oral anticoagulation in a large U.S. registry, the use of a DOAC rather than warfarin was associated with a lower risk of bleeding requiring hospitalization, all-cause mortality, and stroke from discharge to 1 year. Future randomized studies will be necessary to establish the optimal choice of anticoagulant in TAVR patients.
Study context
- Population
- Transcatheter aortic valve replacement (TAVR) recipients who underwent successful TAVR and were discharged on either a direct oral anticoagulants (DOAC) or warfarin between January 2013 and May 2018 (STS/ACC TVT registry)underwent TAVR and were discharged on oral anticoagulation
- Participants
- 29,142 recipients
- Exposure
- DOAC vs warfarin after TAVR
- DOACn = 10,973
- Outcome
- Any bleeding requiring hospitalization
- Follow-up
- From discharge to 1 year
Methodological detailslinked with Centers for Medicare & Medicaid Services claims data, multivariable Cox proportional hazards regression
- Linked with Centers for Medicare & Medicaid Services claims data
- Multivariable Cox proportional hazards regression
Main finding
As reported in the abstract
Adjusted hazard ratio
0.49
95% CI 0.43–0.56
P < 0.001
By group
DOAC vs warfarin
adjusted hazard ratio 0.49 (95% CI 0.43–0.56); P < 0.001
Observational data: associations, not effects.
Secondary outcomes
Cumulative incidence
| Outcome | DOAC | Warfarin | Adjusted hazard ratio (95% CI) | P value | |
|---|---|---|---|---|---|
| All-cause mortality · from discharge to 1 year | 15.5% | 17.5% | 0.61 (0.57–0.66) | P < 0.001 | |
| Stroke · from discharge to 1 year | 2.47% | 2.39% | 0.86 (0.81–0.92) | P < 0.001 | |
| 0.512Adjusted hazard ratio (log scale) |
- All-cause mortality: unadjusted incidence comparison P < .001; adjusted HR P < .001 (all P < .001)
- Stroke: unadjusted incidence comparison P = .64; adjusted HR P < .001 (all P < .001)
Use of DOACs over time
- The use of DOACs increased throughout the study period and exceed the use of warfarin by the final year (2018)
Original publication
Clinical outcomes of direct oral anticoagulant versus warfarin after transcatheter aortic valve replacement: From the STS/ACC TVT registry. Am Heart J. Published 26 February 2025. doi:10.
Summarised from the published abstract; every number is checked against it