Anticoagulation Therapy for Atrial Fibrillation After Transcatheter Aortic Valve Replacement: National Database Insights.

IF 5 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of the American Heart Association Pub Date : 2025-06-23 DOI:10.1161/JAHA.124.040030

Koki Takegawa, Koshiro Kanaoka, Yoshitaka Iwanaga, Tetsuo Sasano, Yuichi Nishioka, Tomoya Myojin, Tatsuya Noda, Tomoaki Imamura, Yoshihiro Miyamoto

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引用次数: 0

Abstract

Background: Transcatheter aortic valve replacement (TAVR) is increasingly used in patients with aortic stenosis; however, the optimal postoperative anticoagulation therapy for patients with atrial fibrillation (AF) remains controversial. We aimed to investigate the association between anticoagulant therapy selection and outcomes in patients with AF after TAVR.

Methods: We retrospectively analyzed patients with AF who underwent TAVR. Patients were divided into 2 groups according to the anticoagulant therapy administered 3 months after the index TAVR (direct oral anticoagulant [DOAC] and vitamin K antagonist [VKA] groups). The primary end points were thromboembolic and major bleeding events after a landmark period of 3 months. We analyzed the association between oral anticoagulants and outcomes using propensity score matching.

Results: Among 47 883 patients who underwent TAVR between April 2014 and March 2021, 10 041 had a history of AF and anticoagulant therapy. Of these, 8191 patients were prescribed a DOAC, while 1850 received a VKA. Before matching, the thromboembolic event rate was 2.2 per 100 person-years in the DOAC group and 3.6 per 100 person-years in the VKA group, whereas the bleeding event rates were 7.1 and 10.0 per 100 person-years, respectively. After matching, VKA was associated with higher risks of thromboembolic events (hazard ratio [HR], 1.46 [95% CI, 1.12-1.91]; P=0.004) and bleeding events (HR, 1.21 [95% CI, 1.03-1.42]; P=0.016).

Conclusions: DOAC use in patients with AF who undergo TAVR may be preferable to VKA use in a real-world clinical setting.

查看原文本刊更多论文

经导管主动脉瓣置换术后房颤的抗凝治疗：国家数据库的见解。

背景：经导管主动脉瓣置换术（TAVR）越来越多地用于主动脉瓣狭窄患者；然而，心房颤动（AF）患者的最佳术后抗凝治疗仍存在争议。我们的目的是研究TAVR后AF患者抗凝治疗选择与预后之间的关系。方法：我们回顾性分析接受TAVR治疗的AF患者。根据TAVR指数达到3个月后的抗凝治疗情况将患者分为两组（直接口服抗凝剂[DOAC]和维生素K拮抗剂[VKA]组）。主要终点是3个月里程碑期后的血栓栓塞和大出血事件。我们使用倾向评分匹配分析了口服抗凝剂与预后之间的关系。结果：在2014年4月至2021年3月期间接受TAVR的47883例患者中，有10041例有房颤和抗凝治疗史。其中，8191名患者服用了DOAC， 1850名患者服用了VKA。配对前，DOAC组的血栓栓塞事件发生率为2.2 / 100人年，VKA组为3.6 / 100人年，而出血事件发生率分别为7.1 / 100人年和10.0 / 100人年。匹配后，VKA与血栓栓塞事件的高风险相关(危险比[HR]， 1.46 [95% CI, 1.12-1.91]；P=0.004)和出血事件(HR, 1.21 [95% CI, 1.03-1.42]；P = 0.016)。结论：在现实世界的临床环境中，在接受TAVR的AF患者中使用DOAC可能优于使用VKA。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of the American Heart Association CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

9.40

自引率

1.90%

发文量

1749

审稿时长

12 weeks

期刊介绍： As an Open Access journal, JAHA - Journal of the American Heart Association is rapidly and freely available, accelerating the translation of strong science into effective practice. JAHA is an authoritative, peer-reviewed Open Access journal focusing on cardiovascular and cerebrovascular disease. JAHA provides a global forum for basic and clinical research and timely reviews on cardiovascular disease and stroke. As an Open Access journal, its content is free on publication to read, download, and share, accelerating the translation of strong science into effective practice.