NOAC monotherapy in patients with concomitant indications for oral anticoagulation undergoing transcatheter aortic valve implantation

作者：Geis Nicolas A^*; Kiriakou Christina; Chorianopoulos Emmanuel; Uhlmann Lorenz; Katus Hugo A; Bekeredjian Raffi

来源：Clinical Research in Cardiology, 2018, 107(9): 799-806.

DOI：10.1007/s00392-018-1247-x

• Transcatheter aortic valve replacement
• Transcatheter aortic valve implantation
• Atrial fibrillation
• NOAC
• Anticoagulation
• Antithrombotic therapy

Antithrombotic therapy after transcatheter aortic valve implantation (TAVI) is highly controversial and guideline recommendations are not evidence based. We assessed efficacy and safety of non-vitamin K antagonist oral anticoagulant (NOAC) monotherapy in patients with concomitant indications for OAC undergoing TAVI.
Among more than 1300 TAVI patients since 2008, 154 patients were identified who received postinterventional NOAC monotherapy. Outcomes were compared to 172 patients treated with vitamin K antagonist (VKA) monotherapy. Thromboembolic as well as bleeding complications were analysed for 6 months after TAVI.
Despite high CHA(2)DS(2)-Vasc (4.6 +/- 1.2), HEMORR(2)HAGES (4.7 +/- 1.9) and HASBLED (2.7 +/- 0.8) scores only three major/life-threatening bleedings and four thromboembolic events occurred after NOAC therapy had been initiated post-TAVI. 12 patients (7.8%) died within 6 months after the procedure. Compared to patients being treated with VKA monotherapy, analysis of a combined end-point of post-procedural death, stroke, embolism and severe bleeding revealed no significant differences (17/154 vs. 14/172; p = 0.45).
The results of this study suggest that NOAC therapy without additional antiplatelet treatment is effective and safe in patients with concomitant indications for OAC undergoing TAVI.

• 出版日期2018-9
• 单位河北医科大学