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Use of Direct Oral Anticoagulant and Outcomes in Patients With Atrial Fibrillation after Transcatheter Aortic Valve Replacement: Insights From the STS/ACC TVT Registry.

Publication ,  Journal Article
Tanawuttiwat, T; Stebbins, A; Marquis-Gravel, G; Vemulapalli, S; Kosinski, AS; Cheng, A
Published in: J Am Heart Assoc
January 4, 2022

Background Clinical evidence on the safety and effectiveness of using direct oral anticoagulants (DOACs) in patients with atrial fibrillation after transcatheter aortic valve replacement (TAVR) remains limited. The aim of this study was to investigate the trends and outcomes of using DOACs in patients with TAVR and atrial fibrillation. Methods and Results Data from the STS/ACC TVT (Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy) Registry was used to identify patients who underwent successful TAVR with preexisting or incident atrial fibrillation who were discharged on oral anticoagulation between January 2013 and May 2018. Patients with a mechanical valve, valve-in-valve procedure, or prior stroke within a year were excluded. The adjusted primary outcome was 1-year stroke events. The adjusted secondary outcomes included bleeding, intracranial hemorrhage, and death. A total of 21 131 patients were included in the study (13 004 TAVR patients were discharged on a vitamin K antagonist and 8127 were discharged on DOACs.) The use of DOACs increased 5.5-fold from 2013 to 2018. The 1-year incidence of stroke was comparable between DOAC-treated patients and vitamin K antagonist-treated patients (2.51% versus 2.37%; hazard ratio [HR], 1.00; 95% CI, 0.81-1.23) whereas DOAC-treated patients had lower 1-year incidence of any bleeding (11.9% versus 15.0%; HR, 0.81; 95% CI, 0.75-0.89), intracranial hemorrhage (0.33% versus 0.59%; HR, 0.54; 95% CI, 0.33-0.87), and death (15.8% versus 18.2%; HR, 0.92; 95% CI, 0.85-1.00). Conclusions In patients with TAVR and atrial fibrillation, DOAC use, when compared with vitamin K antagonists, was associated with comparable stroke risk and significantly lower risks of bleeding, intracranial hemorrhage, and death at 1 year.

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Published In

J Am Heart Assoc

DOI

EISSN

2047-9980

Publication Date

January 4, 2022

Volume

11

Issue

1

Start / End Page

e023561

Location

England

Related Subject Headings

  • Vitamin K
  • United States
  • Treatment Outcome
  • Transcatheter Aortic Valve Replacement
  • Stroke
  • Risk Factors
  • Registries
  • Intracranial Hemorrhages
  • Humans
  • Hemorrhage
 

Citation

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Tanawuttiwat, T., Stebbins, A., Marquis-Gravel, G., Vemulapalli, S., Kosinski, A. S., & Cheng, A. (2022). Use of Direct Oral Anticoagulant and Outcomes in Patients With Atrial Fibrillation after Transcatheter Aortic Valve Replacement: Insights From the STS/ACC TVT Registry. J Am Heart Assoc, 11(1), e023561. https://doi.org/10.1161/JAHA.121.023561
Tanawuttiwat, Tanyanan, Amanda Stebbins, Guillaume Marquis-Gravel, Sreekanth Vemulapalli, Andrzej S. Kosinski, and Alan Cheng. “Use of Direct Oral Anticoagulant and Outcomes in Patients With Atrial Fibrillation after Transcatheter Aortic Valve Replacement: Insights From the STS/ACC TVT Registry.J Am Heart Assoc 11, no. 1 (January 4, 2022): e023561. https://doi.org/10.1161/JAHA.121.023561.
Tanawuttiwat T, Stebbins A, Marquis-Gravel G, Vemulapalli S, Kosinski AS, Cheng A. Use of Direct Oral Anticoagulant and Outcomes in Patients With Atrial Fibrillation after Transcatheter Aortic Valve Replacement: Insights From the STS/ACC TVT Registry. J Am Heart Assoc. 2022 Jan 4;11(1):e023561.
Tanawuttiwat, Tanyanan, et al. “Use of Direct Oral Anticoagulant and Outcomes in Patients With Atrial Fibrillation after Transcatheter Aortic Valve Replacement: Insights From the STS/ACC TVT Registry.J Am Heart Assoc, vol. 11, no. 1, Jan. 2022, p. e023561. Pubmed, doi:10.1161/JAHA.121.023561.
Tanawuttiwat T, Stebbins A, Marquis-Gravel G, Vemulapalli S, Kosinski AS, Cheng A. Use of Direct Oral Anticoagulant and Outcomes in Patients With Atrial Fibrillation after Transcatheter Aortic Valve Replacement: Insights From the STS/ACC TVT Registry. J Am Heart Assoc. 2022 Jan 4;11(1):e023561.
Journal cover image

Published In

J Am Heart Assoc

DOI

EISSN

2047-9980

Publication Date

January 4, 2022

Volume

11

Issue

1

Start / End Page

e023561

Location

England

Related Subject Headings

  • Vitamin K
  • United States
  • Treatment Outcome
  • Transcatheter Aortic Valve Replacement
  • Stroke
  • Risk Factors
  • Registries
  • Intracranial Hemorrhages
  • Humans
  • Hemorrhage