Anticoagulation Continuation During TAVR: Assessing Bleeding, Complication Risks

The continuation of oral anticoagulation during TAVR did not increase bleeding or vascular complication rates.

The continuation of oral anticoagulation with a vitamin K antagonist during transcatheter aortic valve replacement (TAVR) did not increase bleeding or vascular complication rates, according to study results published in JACC: Cardiovascular Interventions.

In this study, researchers examined data from 5 high-volume European centers to compare safety and efficacy of continuation vs interruption of anticoagulant therapy before and after transfemoral TAVR.

A total of 4459 consecutive patients on oral anticoagulation who underwent transfemoral TAVR were included in this analysis. Oral anticoagulation was halted in 733 patients, 2 to 4 days before TAVR, and continued in 584 patients throughout TAVR. The study’s primary safety outcome was major bleeding. Secondary efficacy endpoints were vascular complications, stroke, and mortality.

At the 30-day follow up, the incidence of major or life-threatening bleedings was 11.3% and 14.3% in patients who continued vs stopped oral anticoagulation, respectively (odds ratio [OR], 0.86; 95% CI, 0.61-1.21; P =.39). The incidence of major vascular complications was 11.0% vs 12.3% in the continuation and interruption groups, respectively (OR, 0.89; CI, 0.62-1.27; P =.52).

Patients who continued vs stopped anticoagulation therapy during TAVR often required less transfusion of packed red blood cells (13.7% vs 17.7%, respectively; OR, 0.59; 95% CI, 0.42-0.81; P =.001). Kaplan-Meier estimates of 12-month survival was comparable in the continuation and interruption groups (85.3% vs 84.0%, respectively; hazard ratio, 0.90; 95% CI, 0.73-1.12; P =.36).

Predictors of major or life-threatening bleeding included female sex (OR, 1.59; 95% CI, 1.14-2.23; P =.007), higher CHA2DS2-VASc score (OR, 1.218; 95% CI, 1.043-1.423; P =.013), higher Society of Thoracic Surgeons score (OR, 1.050; 95% CI, 1.020-1.081; P =.001), and lower baseline hemoglobin (OR, 0.98 per g/l; 95% CI, 0.981-0.995; P =.001) in multiple logistic regression analyses.

Limitations of this study include a nonrandomized design.

Based on their findings, the investigators of the study concluded that the “continuation of oral anticoagulation throughout TAVR appears to be safe and effective.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Brinkert M, Mangner N, Moriyama N, et al. Safety and efficacy of transcatheter aortic valve replacement with continuation of vitamin K antagonists or direct oral anticoagulants. Published online December 17, 2020. JACC Cardiovasc Interv. doi:10.1016/j.jcin.2020.09.062