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. 2021 Dec 23:8:780762.
doi: 10.3389/fcvm.2021.780762. eCollection 2021.

Real-World Anticoagulatory Treatment After Transcatheter Aortic Valve Replacement: A Retrospective, Observational Study on 4,800 Patients

Christopher Hohmann  1 , Marion Ludwig  2 , Jochen Walker  2 , Hendrik Wienemann  1 , Stephan Baldus  1 , Roman Pfister  1
Affiliations

Real-World Anticoagulatory Treatment After Transcatheter Aortic Valve Replacement: A Retrospective, Observational Study on 4,800 Patients

Christopher Hohmann et al. Front Cardiovasc Med. .

Abstract

Background: Transcatheter aortic valve replacement (TAVR) has developed to the therapy of choice for patients with symptomatic severe aortic stenosis who are unsuitable for surgical aortic valve replacement and elderly patients with intermediate or high operative risk. However, the optimal anticoagulant therapy post-TAVR still remains a matter of debate. Aims: This study sought to investigate current anticoagulant treatment patterns and clinical outcome in patients undergoing TAVR. Methods: In a retrospective study based on anonymized health claims data of approximately seven million Germans with statutory health insurance (InGef database), anticoagulant treatment regimens were assessed using any drug prescription post discharge within the first 90 days after TAVR procedure. Clinical events between 30 days and 6 months were examined by treatment regime. Results: The study population comprised 4,812 patients with TAVR between 2014 and 2018: 29.4% received antiplatelet monotherapy, 17.8% dual antiplatelet therapy, 17.4% oral anticoagulation (OAC) plus antiplatelet therapy, 12.9% OAC monotherapy, 2.2% triple therapy and 19.2% did not receive any anticoagulatory drugs. Sixty-four percentage of patients with OAC received direct oral anticoagulants (DOAC). Hence, 68% of all patients were treated non-adherent to current guidelines. Forty percentage of patients with OAC prior to TAVR did not have any OAC after TAVR. The adjusted risk of all-cause mortality was significantly increased in patients with OAC (HR 1.40, 95% CI 1.03-1.90, p = 0.03) and no anticoagulatory treatment (HR 3.95, 95% CI 2.95-5.27, p < 0.0001) when compared to antiplatelet monotherapy. Conclusions: This large real-world data analysis demonstrates substantial deviations from guideline recommendations and treatment after TAVR. Considering relevant differences in clinical outcome across treatment groups, major effort is warranted to examine underlying causes and improve guideline adherence.

Keywords: DOAC; TAVR; anticoagulation; antithrombotic therapy; real-world.

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Conflict of interest statement

ML and JW were employed by company InGef-Institute for Applied Health Research Berlin GmbH. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Frequency of post-TAVR anticoagulant treatment regimes in the total population (A) and rate of treatments incompliant to current guideline recommendation in patients surviving first 30 days after TAVR (B).
Figure 2
Figure 2
Preprocedural anticoagulant regimes in patients surviving first 30 days after TAVR with (A) postprocedural antiplatelet monotherapy and (B) postprocedural no antiplatelet or anticoagulation therapy.
Figure 3
Figure 3
Frequency of post-TAVR anticoagulant treatment regimes in patients with (A) OAC prior to TAVR, (B) DOAC prior to TAVR and (C) VKA prior to TAVR.
See this image and copyright information in PMC

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References

    1. Baumgartner H, Falk V, Bax JJ, De Bonis M, Hamm C, Holm PJ, et al. . 2017 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J. (2017) 38:2739–91. 10.1093/eurheartj/ehx391 - DOI - PubMed
    1. Thourani VH, Kodali S, Makkar RR, Herrmann HC, Williams M, Babaliaros V, et al. . Transcatheter aortic valve replacement versus surgical valve replacement in intermediate risk-patients: a propensity score analysis. Lancet. (2016) 387:2218–25. 10.1016/S0140-6736(16)30073-3 - DOI - PubMed
    1. Leon MB, Smith CR, Mack MJ, Makkar RR, Svensson LG, Kodali SK, et al. . Transcatheter or surgical aortic-valve replacement in intermediate-risk patients. N Engl J Med. (2016) 374:1609–20. 10.1056/NEJMoa1514616 - DOI - PubMed
    1. Eggebrecht H, Schmermund A, Voigtländer T, Kahlert P, Erbel R, Mehta RH. Risk of stroke after transcatheter aortic valve implantation (TAVI): a meta-analysis of 10,037 published patients. EuroIntervention. (2012) 8:129–38. 10.4244/EIJV8I1A20 - DOI - PubMed
    1. Makkar RR, Fontana GP, Jilaihawi H, Kapadia S, Pichard AD, Douglas PS, et al. . Transcatheter aortic valve replacement for inoperable severe aortic stenosis. N Engl J Med. (2012) 366:1696–704. 10.1056/NEJMoa1202277 - DOI - PubMed

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