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Comparative Study
. 2025 Dec 1:256:60-65.
doi: 10.1016/j.amjcard.2025.07.013. Epub 2025 Jul 17.

Vitamin K Antagonists Versus Direct Oral Anticoagulation After Transcatheter Mitral Valve Replacement

Maja Wichhart Donzo  1 , Elsa Hebbo  1 , Hiroki A Ueyama  1 , Arslan Zahid  1 , Adam B Greenbaum  1 , Joe X Xie  1 , Andrew Murphy  1 , Swapnil Garg  1 , Anton Camaj  1 , Juan D Del Cid Fratti  1 , Anas Noman  1 , Chandan M Devireddy  1 , George Hanzel  1 , Nikoloz Shekiladze  1 , John C Lisko  1 , Isida Byku  1 , Vasilis Babaliaros  1 , Patrick T Gleason  2
Affiliations
Comparative Study

Vitamin K Antagonists Versus Direct Oral Anticoagulation After Transcatheter Mitral Valve Replacement

Maja Wichhart Donzo et al. Am J Cardiol. .

Abstract

Optimal anticoagulation strategies after transcatheter mitral valve replacement (TMVR) remain unknown with no randomized trial data. Current practices for anticoagulation after TMVR vary widely as a result. We aimed to compare clinical outcomes between vitamin K antagonists (VKA) and direct oral anticoagulation (DOAC) after transcatheter mitral valve replacement (TMVR) at our institution. We included consecutive patients who underwent valve in valve (ViV) or valve in ring (ViR) TMVR between 2012 and 2022. Clinical outcomes and valve hemodynamics were compared between VKA and DOAC. Primary outcome was major adverse cardiovascular (MACE), defined as composite of all-cause death, stroke, or valve thrombosis. A total of 148 patients (84 VKA and 64 DOAC) were included. The VKA group had a higher prevalence of myocardial infarction, atrial fibrillation/flutter, and pacemakers. Survival analysis showed no significant difference in cumulative survival free of MACE over 1 year (p = 0.68). Mitral valve mean gradient significantly reduced after intervention (12.9 mmHg to 7.8 mmHg in VKA patients and 10.7 mmHg to 7.5 mmHg in DOAC patients) and was maintained over 1 year without difference between groups (7.6 mmHg and 7.6 mmHg). In conclusion, there was no difference in outcomes between DOAC and VKA after TMVR. Data from randomized clinical trials is still needed to assess efficacy and safety in a larger population.

Keywords: DOAC; VKA; antithrombotic therapy; transcatheter mitral valve replacement; transcatheter therapy; valve thrombosis.

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Conflict of interest statement

Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Drs Ueyama, Inci, Lisko, Xie, Byku, Hanzel, Greenbaum, Devireddy, Babaliaros, and Gleason have received institutional research support from Abbott Vascular, Ancora Heart, Edwards Lifesciences, Gore Medical, JenaValve, Medtronic, Polares Medical, Transmural Systems, and 4C Medical. Dr Byku has served as a consultant for Edwards Lifesciences and Shockwave Medical. Dr. Devireddy has served as a consultant to Medtronic and Recor Medical. Dr Hanzel has served as a consultant for Medtronic. Dr Greenbaum has served as a consultant to Abbott Vascular, Edwards Lifesciences, Excision Medical, and Medtronic; and has equity interests in Transmural Systems and Excision Medical. Dr Babaliaros has served as a consultant to Abbott Vascular, Edwards Lifesciences, and Medtronic; and has equity interest in Transmural Systems. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. This manuscript was written without the assistance of artificial intelligence.

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