Direct oral anticoagulants versus vitamin K antagonist after transcatheter aortic valve implantation

Hohmann, C; Pfister, R; Frerker, C; Beckmann, A; Walther, T; Bleiziffer, S; Ensminger, S; Bekeredjian, R; Seiffert, M; Sinning, JM; Möllmann, H; Beyersdorf, F; Baldus, S; Böning, A; Herrmann, E; Balaban, Ü; Kuhn, E; GARY Executive Board

doi:10.1136/heartjnl-2023-322548

Valvular & structural heart disease

Direct oral anticoagulants versus vitamin K antagonist after transcatheter aortic valve implantation

HeartPublished 5 Jul 2023Prospective registry cohort study

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Authors' conclusion

This study supports evidence of the efficacy of DOAC use after TAVI in patients with an indication for oral anticoagulation.

Study context

Population: Patients after transcatheter aortic valve implantation (TAVI) with an indication for oral anticoagulation, German Aortic Valve RegistrY (GARY), 2011–2019of 45,598 TAVI patients
Participants: 16,974 patients

Exposure: DOAC vs VKA after TAVI
DOACn = 5,641
VKAn = 11,333reference
Outcome: All-cause mortality and combined cardiac and cerebrovascular events (MI, stroke, TIA, aortic prosthesis reintervention, all-cause mortality)
Follow-up: First year after TAVI

Methodological detailsmulticentre, 92 hospitals in Germany, adjusted for baseline confounders

Multicentre
92 hospitals in Germany
Adjusted for baseline confounders

Main finding

As reported in the abstract

1-year follow-up

VKA

All-cause mortality: 1.9 per 100 person-years
Cardiac and cerebrovascular events: 1.3 per 100 person-years

DOAC

All-cause mortality: 1.7 per 100 person-years
Cardiac and cerebrovascular events: 1.2 per 100 person-years

All-cause mortality

VKA1.9 per 100 person-years

DOAC1.7 per 100 person-years

Cardiac and cerebrovascular events

VKA1.3 per 100 person-years

DOAC1.2 per 100 person-years

DOAC vs VKAHazard ratio (95% CI)P value

All-cause mortality; adjusted; direction not stated ("between VKA and DOAC groups")

0.95(0.88–1.01)

P = 0.114

Cardiac and cerebrovascular event-free survival; adjusted; direction not stated

0.93(0.86–1.01)

P = 0.071

Observational data: associations, not effects.

Further findings

DOAC use among anticoagulated patients over time

DOAC use in 2011: 9.4%
DOAC use in 2019: 69.9%

Original publication

Direct oral anticoagulants versus vitamin K antagonist after transcatheter aortic valve implantation. Heart. Published 5 July 2023. doi:10.1136/heartjnl-2023-322548

Read the original article ↗

Summarised from the published abstract; every number is checked against it