Comparing Vitamin K Antagonists and Direct Oral Anticoagulants in Patients With Atrial Fibrillation Undergoing Transcatheter Aortic Valve Replacement: A Meta-Analysis

Lee, Wei‐Chieh; Shih, Jhih-Yuan; Fang, Hsiu‐Yu; Wu, Po‐Jui; Fang, Chih-Yuan; Chen, Huang‐Chung; Fang, Yueh‐Fu; Chang, Wei‐Ting; Chen, Mien‐Cheng

doi:10.1177/10760296231158585

Cited by 7 publications

(2 citation statements)

References 28 publications

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“…The largest registry to date, from the US, found similar stroke rates with DOAC and VKA but lower rates of any bleeding and of intracranial hemorrhage as well as all-cause mortality (15.8% vs 18.2% mortality; HR 0.92, 95% CI 0.85-1.00). 72 With these mixed study results and inconclusive results even from meta-analysis, [73][74][75] randomized controlled trials were needed to determine if DOACs offer a clinical advantage over a VKA in patients undergoing TAVR. 5).…”

Section: Doacsmentioning

confidence: 99%

Antithrombotic therapy with Transcatheter aortic valve replacement

Dobesh

Goldsweig

2023

Pharmacotherapy

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Aortic valve replacement is a necessary management strategy for patients with severe aortic stenosis. The use of transaortic valve replacement (TAVR) has increased significantly over the last decade and now exceeds traditional surgical aortic valve replacement. Since the valve systems used in TAVR consist of bioprosthetic valve tissue encased in a metal stent frame, antithrombotic therapy recommendations cannot be extrapolated from prior data with differently constructed surgical bioprosthetic or mechanical valves. Data on the use of antithrombotic therapy with TAVR are a rapidly developing area of medicine. Choice of agents depends on several patient factors. Patients undergoing TAVR also have a relatively high incidence of subclinical valve thrombosis. The clinical impact of this phenomenon and the implications for antithrombotic therapy continue to evolve. It is critical for clinicians who treat patients undergoing TAVR to have a firm understanding of practice guidelines, the evolving evidence, and its implications for the use of antithrombotic therapy in these patients.

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Section: Doacsmentioning

confidence: 99%

Antithrombotic therapy with Transcatheter aortic valve replacement

Dobesh

Goldsweig

2023

Pharmacotherapy

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“…In the realm of anticoagulant and antiplatelet therapies, two distinct categories emerge: direct oral anticoagulants (DOACs) and vitamin K antagonists (VKAs), juxtaposed to antiplatelet agents such as P2Y12 inhibitors, acetylsalicylic acid (ASS), and heparin. These therapeutic classes play pivotal roles in managing various cardiovascular and thrombotic conditions, though they differ in mechanisms, administration, indications, and risk profiles [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Epidemiology of maxillofacial trauma in elderly patients receiving oral anticoagulant or antithrombotic medication; a Swiss retrospective study

Bettschen,

Tsichlaki,

Chatzimichail

et al. 2024

BMC Emerg Med

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Background The percentage of elderly trauma patients under anticoagulation and antiplatelet agents has been rising lately. As newer agents are introduced, each comes with its own advantages and precautions. Our study covered elderly patients admitted to the ED with maxillofacial trauma while on anticoagulation (AC) or antiplatelet therapy (APT). We aimed to investigate the demographic characteristics, causes, and types of maxillofacial trauma, along with concomitant injuries, duration of hospitalisation, haemorrhagic complications, and the overall costs of care in the emergency department (ED). Methods Data were gathered from the ED of Bern University Hospital. In this retrospective analysis, patients over 65 of age were included, who presented at our ED with maxillofacial trauma between 2013 and 2019 while undergoing treatment with therapeutic AC/APT. Results The study involved 188 patients with a median age of 81 years (IQR: 81 [74; 87]), of whom 55.3% (n=104) were male. More than half (54.8%, n=103) were aged 80 years or older. Cardiovascular diseases were present in 69.7% (n=131) of the patients, with the most common indications for AC/APT use being previous thromboembolic events (41.5%, n=78) and atrial fibrillation (25.5%, n=48). The predominant cause of facial injury was falls, accounting for 83.5% (n=157) of cases, followed by bicycle accidents (6.9%, n=13) and road-traffic accidents (5.3%, n=10). The most common primary injuries were fractures of the orbital floor and/or medial/lateral wall (60.1%, n=113), zygomatic bone (30.3%, n=57), followed by isolated orbital floor fractures (23.4%, n=44) and nasal bone fractures (19.1%, n=36). Fractures of the mandible occurred in 14.9% (n=28). Facial hematomas occurred in 68.6% of patients (129 cases), primarily in the midface area. Relevant facial bleeding complications were intracerebral haemorrhage being the most frequent (28.2%, n=53), followed by epistaxis (12.2%, n=23) and retrobulbar/intraorbital hematoma (9%, n=17). Sixteen patients (8.5%) experienced heavy bleeding that required emergency treatment. The in-hospital mortality rate was 2.1% (4 cases). Conclusions This study indicates that falls are the leading cause of maxillofacial trauma in the elderly, with the most common diagnoses being orbital, zygomatic, and nasal fractures. Haemorrhagic complications primarily involve facial hematomas, especially in the middle third of the face, with intracerebral haemorrhage being the second most frequent. Surgical intervention for bleeding was required in 8.5% of cases. Given the aging population, it is essential to improve prevention strategies and update safety protocols, particularly for patients on anticoagulant/antiplatelet therapy (AC/APT). This can ensure rapid diagnostic imaging and prompt treatment in emergencies.

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