Valvular & structural heart diseaseCohort study
Non–Vitamin K Antagonist Versus Vitamin K Antagonist Oral Anticoagulant Agents After Transcatheter Aortic Valve Replacement
- Prospective registry cohort study
- propensity-score matched
- national registry
Authors' conclusion
At 5 years after TAVR, VKAs are associated with a higher risk for all-cause mortality, a lower risk for disabling stroke, and a similar rate of life-threatening or major bleeding compared with DOACs.
Study context
- Population
- Consecutive patients undergoing transfemoral transcatheter aortic valve replacement (TAVR) with concomitant indications for OAC, SwissTAVI Registry, February 2011–June 2021matched cohort
- Participants
- 1,454 vs 1,454
- Exposure
- VKA vs DOAC after transfemoral TAVR
- VKAn = 1,454
- DOACn = 1,454reference
- Outcome
- Net clinical benefit (all-cause mortality, MI, stroke, life-threatening or major bleeding); primary safety endpoint: life-threatening and major bleeding
- Follow-up
- 30 days, 1 year and 5 years after TAVR
Main finding
As reported in the abstract
Net clinical benefit and primary safety endpoint · 30 days, 1 and 5 years
- No significant difference between VKA and DOAC in net clinical benefit and safety endpoints at 30 days, 1 and 5 years
- matched cohort
Observational data: associations, not effects.
Further findings
| Outcome | HR (95% CI) | |
|---|---|---|
| All-cause mortality · 1 year | 1.28 (1.01–1.62) | |
| All-cause mortality · 5 years | 1.25 (1.11–1.40) | |
| Disabling stroke, long-term (excluding periprocedural events) · lower with VKA | 0.64 (0.46–0.90) | |
| 0.512Hazard ratio (log scale) |
Original publication
Non–Vitamin K Antagonist Versus Vitamin K Antagonist Oral Anticoagulant Agents After Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv. Published 12 February 2024. doi:10.1016/j.jcin.2023.11.038
Summarised from the published abstract; every number is checked against it