Pre-Operative Continued Oral Anticoagulation Impact on Early Outcomes after Transcatheter Aortic Valve Implantation

Tagliari, Ana Paula; Pérez-Camargo, Daniel; Ferrari, Enrico; Haager, Philipp K.; Jörg, Lucas; Gennari, Marco; Mi, Chen; Gavazzoni, Mara; Khattab, Ahmed A.; Blöchlinger, Stefan; Taramasso, Maurizio

doi:10.1016/j.amjcard.2021.03.022

Cited by 4 publications

(2 citation statements)

References 21 publications

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“…Few observational studies have evaluated the continuation of OAC during TAVR in patients requiring long-term anticoagulation. Compared to pre-TAVR interruption of OAC, continuation of OAC throughout the intervention did not increase in-hospital or 30-day bleeding rates, nor vascular complications [132][133][134]. An observational cohort reported 30-day major or life-threatening bleeding was not significantly higher in patients with continuation versus interruption of anticoagulation (11.3% vs. 14.3%, respectively, OR 0.86, p = 0.39), as well as major vascular complications (11.0% vs. 12.3%, OR 0.89, p = 0.52) [132].…”

Section: Periprocedural Antithrombotic Therapymentioning

confidence: 96%

Antithrombotic Therapy Following Transcatheter Aortic Valve Replacement

Guedeney

Collet

2022

JCM

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Due to a large technical improvement in the past decade, transcatheter aortic valve replacement (TAVR) has expanded to lower-surgical-risk patients with symptomatic and severe aortic stenosis. While mortality rates related to TAVR are decreasing, the prognosis of patients is still impacted by ischemic and bleeding complications, and defining the optimal antithrombotic regimen remains a priority. Recent randomized control trials reported lower bleeding rates with an equivalent risk in ischemic outcomes with single antiplatelet therapy (SAPT) when compared to dual antiplatelet therapy (DAPT) in patients without an underlying indication for anticoagulation. In patients requiring lifelong oral anticoagulation (OAC), the association of OAC plus antiplatelet therapy leads to a higher risk of bleeding events with no advantages on mortality or ischemic outcomes. Considering these data, guidelines have recently been updated and now recommend SAPT and OAC alone for TAVR patients without and with a long-term indication for anticoagulation. Whether a direct oral anticoagulant or vitamin K antagonist provides better outcomes in patients in need of anticoagulation remains uncertain, as recent trials showed a similar impact on ischemic and bleeding outcomes with apixaban but higher gastrointestinal bleeding with edoxaban. This review aims to summarize the most recently published data in the field, as well as describe unresolved issues.

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Section: Periprocedural Antithrombotic Therapymentioning

confidence: 96%

Antithrombotic Therapy Following Transcatheter Aortic Valve Replacement

Guedeney

Collet

2022

JCM

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“…A bridging strategy with low-molecular weight heparin is optional and, based on local practice, is restarted for OAC after an uncomplicated intervention ( 36 , 37 ). Recent evidence suggests that TAVI in patients with OAC may be as safe as and equivalent to an OAC interruption strategy ( 40 – 42 ).…”

Section: Antithrombotic Therapy In Transcatheter Aortic Valve Implant...mentioning

confidence: 99%

Stroke prevention during and after transcatheter aortic valve implantation: From cerebral protection devices to antithrombotic management

Díaz

Estévez‐Loureiro

Alonso

et al. 2022

Front. Cardiovasc. Med.

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Since its conception, transcatheter aortic valve implantation (TAVI) has undergone important improvements both in the implantation technique and in transcatheter devices, allowing an enthusiastic adoption of this therapeutic approach in a wide population of patients previously without a surgical option and managed conservatively. Nowadays, patients with severe symptomatic aortic stenosis are typically managed with TAVI, regardless of their risk to surgery, improving the prognosis of patients and thus achieving an exponential global expansion of its use. However, thromboembolic and hemorrhagic complications remain a latent concern in TAVI recipients. Both complications can appear simultaneously in the periprocedural period or during the follow-up, and when minor, they resolved without apparent sequelae, but in a relevant percentage of cases, they are devastating, overshadowing the benefit achieved with TAVI. Our review outlines the etiology and incidence of thromboembolic complications associated with TAVI, the main current strategies for their prevention, and the implications of its pharmacological management at the follow-up in a TAVI population, mostly frail and predisposed to bleeding complications.

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