Routine use of anticoagulation after transcatheter aortic valve replacement: Initial safety outcomes from a single-center experience

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Abstract

Background: Subclinical leaflet thrombosis (SCLT) can be seen in up to 12% of patients after transcatheter aortic valve replacement (TAVR). Anticoagulation appears to prevent and reverse SCLT but concerns exist about bleeding risk. Methods: Our program adopted a strategy of routine anticoagulation after TAVR, starting warfarin on post-procedure day 0 and continuing for 3 months in 10/2015. We report the initial safety and efficacy outcomes of this approach. Bleeding events were assessed using Valve Academic Research Consortium (VARC) and Bleeding Academic Research Consortium (BARC) definitions. Results: The median (IQR) age of the population (n = 191) was 82 years (72–87) and the median (IQR) STS score was 5.6% (3–8). A total of 101 (53%) patients were discharged on anticoagulation (warfarin 97%) while 90 (47%) received antiplatelet therapy alone. The mean duration of anticoagulation therapy was 81 ± 17 days. During follow-up 7 patients (4%) had a stroke or TIA, 3 (3%) in the anticoagulation group and 4 (4%) in the antiplatelet group (p = 0.71). A total of 8 patients (4.2%) had BARC bleeding events during follow-up, 3 patients in the anticoagulation group (2.9%) and 5 in the antiplatelet group (5.5%, p = 0.48). All bleeding events (VARC and BARC) were numerically lower in the anticoagulation group (8% versus 13%, p = 0.20). Conclusions: A strategy of routine anticoagulation for 3-months after TAVR is well tolerated and associated with similar or lower bleeding risk compared to antiplatelet therapy.

Original languageEnglish (US)
Pages (from-to)621-625
Number of pages5
JournalCardiovascular Revascularization Medicine
Volume19
Issue number5
DOIs
StatePublished - Jul 1 2018

Bibliographical note

Funding Information:
Disclosures: Dr. Santiago Garcia has received research support from Edwards Lifesciences and consultant honoraria from Surmodics, Medtronic, and Boston Scientific. Dr. Garcia is a recipient of a career development award ( 1IK2CX000699–01 ) from the VA Office of Research and Development . Dr. Yannopoulos is the PI and co-PI for the following NIH (NHLBI) grants: R01 HL123227 , 1R01HL126092 -01 , R01HL1223231 , R43HL123194-01 1R43HL110517-01A1 , R43HL115937-01 . Dr Yannopoulos also received funds for the Minnesota Resuscitation Consortium from the Medtronic Foundation . The other authors have no conflicts to report related to this manuscript.

Funding Information:
Disclosures: Dr. Santiago Garcia has received research support from Edwards Lifesciences and consultant honoraria from Surmodics, Medtronic, and Boston Scientific. Dr. Garcia is a recipient of a career development award (1IK2CX000699?01) from the VA Office of Research and Development. Dr. Yannopoulos is the PI and co-PI for the following NIH (NHLBI) grants: R01 HL123227, 1R01HL126092 -01, R01HL1223231, R43HL123194-01 1R43HL110517-01A1, R43HL115937-01. Dr Yannopoulos also received funds for the Minnesota Resuscitation Consortium from the Medtronic Foundation. The other authors have no conflicts to report related to this manuscript.

Publisher Copyright:
© 2017

Copyright:
Copyright 2018 Elsevier B.V., All rights reserved.

Keywords

  • Anticoagulation
  • Outcomes
  • Safety
  • Transcatheter valve replacement

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