Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Jan;55(1):181-184.
doi: 10.1007/s11239-022-02721-6. Epub 2022 Nov 1.

TAVR: nemesis of NOACs?

Amin Polzin #  1 , Carolin Helten #  2 , Daniel Metzen  2 , Saif Zako  2 , Verena Veulemans  2 , Malte Kelm  2 , Tobias Zeus  2
Affiliations

TAVR: nemesis of NOACs?

Amin Polzin et al. J Thromb Thrombolysis. 2023 Jan.

Abstract

Data on non-vitamin K antagonist oral anticoagulants (NOACs) in transcatheter aortic valve replacement (TAVR) patients are controversial. In patients without atrial fibrillation (AF), rivaroxaban showed enhanced ischemia and bleeding as compared to standard of care. ENVISAGE showed enhanced bleeding in AF patients as compared to vitamin K antagonist (VKA). Only apixaban was non-inferior but failed superiority regarding bleeding in AF patients after TAVR. One could hypothesize that this might be due to pharmacokinetics of NOACs. Therefore, we compared outcome in rivaroxaban/edoxaban (once-daily) and apixaban (twice-daily) treated patients. 568 patients with indication for permanent oral anticoagulation due to AF undergoing TAVR were analyzed via inverse probability of treatment weighting. Valve academic research consortium complications during 30-day follow-up were assessed. Bleeding complications were similar in once-daily and twice-daily NOACs (major: 22 (7.5%) vs. 14 (5.3%), p = 0.285; minor: 66 (22.4%) vs. 46 (17.4%), p = 0.133). Complications did not change when splitting the cohort in the different agents apixaban, rivaroxaban and edoxaban. These findings remained robust after multivariate analysis. In summary, twice-daily and once-daily NOACs did not differ regarding bleeding complications in a hypothesis generating real-world cohort of TAVR patients with AF.

Keywords: Bleeding; NOAC; TAVR.

PubMed Disclaimer

Conflict of interest statement

Amin Polzin declares consulting and paid speaking fees for Bayer, Bristol-Myers Squibb/Pfizer and Daiichi Sankyo. Tobias Zeus declares consulting and paid speaking fees for Bayer and Daiichi Sankyo. Carolin Helten, Daniel Metzen, Saif Zako, Verena Veulemans and Malte Kelm have nothing to declare.

References

    1. Steffel J, Collins R, Antz M, et al. 2021 European heart rhythm association practical guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation. Europace. 2021;23(10):1612–1676. doi: 10.1093/europace/euab065. - DOI - PMC - PubMed
    1. Collet JPVBE, Thiele E, Berti E, Lhermusier T, Manigold T, Neumann F, Gilard M, Attias D, Beygui F, Cequier A, Alfonso F, Aubry P, Baronnet F, Ederhy S, El Kasty M, Kerneis M, Barthelemy O, Lefèvre T, Leprince P, Redheuil A, Henry P, Portal J, Vicaut E, Montalescot G (2021) Apixaban twice daily or standard-of-care after transcatheter aortic valve implantation for aortic stenosis (ATLANTIS): a randomized, open-label, phase 3 trial. American College of Cardiology Virtual Annual Scientific Session (ACC 2021)
    1. Lin SY, Kuo CH, Yeh SJ, et al. Real-world rivaroxaban and apixaban levels in Asian patients with atrial fibrillation. Clin Pharmacol Ther. 2020;107(1):278–286. doi: 10.1002/cpt.1601. - DOI - PMC - PubMed
    1. Petzold T, Thienel M, Dannenberg L, et al. Rivaroxaban reduces arterial thrombosis by inhibition of FXa-driven platelet activation via protease activated receptor-1. Circ Res. 2020;126(4):486–500. doi: 10.1161/CIRCRESAHA.119.315099. - DOI - PubMed
    1. Testa S, Legnani C, Antonucci E, et al. Drug levels and bleeding complications in atrial fibrillation patients treated with direct oral anticoagulants. J Thromb Haemost. 2019;17(7):1064–1072. doi: 10.1111/jth.14457. - DOI - PMC - PubMed

MeSH terms