Oral Anticoagulant Type and Outcomes After Transcatheter Aortic Valve Replacement.

Autor:	Jochheim D; Department of Cardiology, Munich University Clinic, Ludwig-Maximilians University, Munich, Germany; German Centre for Cardiovascular Research, partner site Munich Heart Alliance, Munich, Germany., Barbanti M; Department of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy., Capretti G; Department of Cardiology, Università Vita-Salute San Raffaele, Milano, Italy., Stefanini GG; Department of Cardiology, Istituto Clinico Humanitas, Rozzano, Italy., Hapfelmeier A; Institute of Medical Informatics, Statistics and Epidemiology, Technical University Munich, Munich, Germany., Zadrozny M; Department of Cardiology, Munich University Clinic, Ludwig-Maximilians University, Munich, Germany., Baquet M; Department of Cardiology, Munich University Clinic, Ludwig-Maximilians University, Munich, Germany; German Centre for Cardiovascular Research, partner site Munich Heart Alliance, Munich, Germany., Fischer J; Department of Cardiology, Munich University Clinic, Ludwig-Maximilians University, Munich, Germany., Theiss H; Department of Cardiology, Munich University Clinic, Ludwig-Maximilians University, Munich, Germany., Todaro D; Department of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy., Chieffo A; Department of Cardiology, Università Vita-Salute San Raffaele, Milano, Italy., Presbitero P; Department of Cardiology, Istituto Clinico Humanitas, Rozzano, Italy., Colombo A; Department of Cardiology, Università Vita-Salute San Raffaele, Milano, Italy., Massberg S; Department of Cardiology, Munich University Clinic, Ludwig-Maximilians University, Munich, Germany; German Centre for Cardiovascular Research, partner site Munich Heart Alliance, Munich, Germany., Tamburino C; Department of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy., Mehilli J; Department of Cardiology, Munich University Clinic, Ludwig-Maximilians University, Munich, Germany; German Centre for Cardiovascular Research, partner site Munich Heart Alliance, Munich, Germany. Electronic address: julinda.mehilli@med.uni-muenchen.de.
Jazyk:	angličtina
Zdroj:	JACC. Cardiovascular interventions [JACC Cardiovasc Interv] 2019 Aug 26; Vol. 12 (16), pp. 1566-1576. Date of Electronic Publication: 2019 Jun 12.
DOI:	10.1016/j.jcin.2019.03.003
Abstrakt:	Objectives: The purpose of the study was to investigate the impact of oral anticoagulation (OAC) type on clinical outcomes 1 year after transcatheter aortic valve replacement (TAVR). Background: Non-vitamin K oral anticoagulants (NOACs) are superior to vitamin K antagonists (VKAs) in nonvalvular atrial fibrillation (AF), while their comparative performance among patients in need of OAC undergoing TAVR is underinvestigated. Methods: The study enrolled 962 consecutive patients who underwent TAVR in 4 tertiary European centers and were discharged on either NOACs (n = 326) or VKAs (n = 636). By using propensity scores for inverse probability of treatment weighting (IPTW), the comparison of treatment groups was adjusted to correct for potential confounding. Results: Mean age and Society of Thoracic Surgeons score of the population were 81.3 ± 6.3 years and 4.5% (interquartile range: 3.0% to 7.3%); 52.5% were women and a balloon-expandable valve was used in 62.7% of cases. The primary outcome of interest, combined incidence of all-cause mortality, myocardial infarction, and any cerebrovascular event at 1-year after TAVR, was 21.2% with NOACs versus 15.0% with VKAs (hazard ratio [HR]: 1.44; 95% confidence interval [CI]: 1.00 to 2.07; p = 0.050, IPTW-adjusted). The 1-year incidence of any Bleeding Academic Research Consortium bleeds and all-cause mortality were comparable between the NOAC and VKA groups, 33.9% versus 34.1% (HR: 0.97; 95% CI: 0.74 to 1.26; p = 0.838, IPTW-adjusted) and 16.5% versus 12.2% (HR: 1.36; 95% CI: 0.90 to 2.06; p = 0.136, IPTW-adjusted), respectively. Conclusions: Chronic use of both NOACs and VKAs among patients in need of OAC after TAVR are comparable regarding 1-year bleeding risk. The higher ischemic event rate observed with NOACs needs to be evaluated in large randomized trials. (Copyright © 2019 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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