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Original research article
Impact of anticoagulation therapy on valve haemodynamic deterioration following transcatheter aortic valve replacement
  1. María Del Trigo1,
  2. Antonio J Muñoz-García2,
  3. Azeem Latib3,
  4. Vincent Auffret4,
  5. Harindra C Wijeysundera5,
  6. Luis Nombela-Franco6,
  7. Enrique Gutierrez7,
  8. Asim N Cheema8,
  9. Vicenç Serra9,
  10. Ignacio J Amat-Santos10,
  11. Joelle Kefer11,
  12. Luis Miguel Benitez12,
  13. Florence Leclercq13,
  14. Antonio Mangieri3,
  15. Hervé Le Breton4,
  16. Pilar Jiménez-Quevedo6,
  17. Bruno Garcia del Blanco9,
  18. Antonio Dager12,
  19. Omar Abdul-Jawad Altisent1,
  20. Rishi Puri1,
  21. Philippe Pibarot1,
  22. Josep Rodés-Cabau1
  1. 1Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
  2. 2Department of Cardiology, Hospital Universitario Virgen de la Victoria, Málaga, Spain
  3. 3Department of Interventional Cardiology, San Raffaele Hospital, Milan, Italy
  4. 4Service de cardiologie et maladies vasculaires, Pontchaillou University Hospital, Rennes, France
  5. 5Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
  6. 6Department of Interventional Cardiology, Instituto Cardiovascular, Hospital Clinico San Carlos, IdISSC., Madrid, Spain
  7. 7Department of Interventional Cardiology, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
  8. 8Department of Interventional Cardiology, St Michael’s Hospital, Toronto, Ontario, Canada
  9. 9Department of Interventional Cardiology, Hospital Universitario Vall d’Hebron, Barcelona, Spain
  10. 10Cardiology Department, Hospital Clinico Univeritario de Valladolid, Valladolid, Spain
  11. 11Cardiology Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium
  12. 12Cardiology Department, Clinica de Occidente de Cali, Valle del Cauca, Colombia
  13. 13Département de Cardiologie et Maladies Vasculaires, Arnaud deVilleneuve University Hospital, Montpellier, France
  1. Correspondence to Dr Josep Rodés-Cabau, Quebec Heart and Lung Institute, Laval University, Quebec City, G1V 4GS, Canada; josep.rodes{at}criucpq.ulaval.ca

Abstract

Objective To evaluate the changes in transvalvular gradients and the incidence of valve haemodynamic deterioration (VHD) following transcatheter aortic valve replacement (TAVR), according to use of anticoagulation therapy.

Methods and results This multicentre study included 2466 patients (46% men; mean age 81±7 years) who underwent TAVR with echocardiography performed at 12-month follow-up. Anticoagulation therapy was used in 707 patients (28.7%) following TAVR (AC group). A total of 663 patients received vitamin K antagonists, and 44 patients received direct oral anticoagulants. A propensity score matching analysis was performed to adjust for intergroup (AC vs non-AC post-TAVR) differences. A total of 622 patients per group were included in the propensity-matched analysis. VHD was defined as a ≥10 mm Hg increase in the mean transprosthetic gradient at follow-up (vs hospital discharge). The mean clinical follow-up was 29±18 months. The mean transvalvular gradient significantly increased at follow-up in the non-AC group within the global cohort (P=0.003), whereas it remained stable over time in the AC group (P=0.323). The incidence of VHD was significantly lower in the AC group (0.6%) compared with the non-AC group (3.7%, P<0.001), and these significant differences remained within the propensity-matched populations (0.6% vs 3.9% in the AC and non-AC groups, respectively, P<0.001). The occurrence of VHD did not associate with an increased risk of all-cause death (P=0.468), cardiovascular death (P=0.539) or stroke (P=0.170) at follow-up.

Conclusions The lack of anticoagulation therapy post-TAVR was associated with significant increments in transvalvular gradients and a greater risk of VHD. VHD was subclinical in most cases and did not associate with major adverse clinical events. Future randomised trials are needed to determine if systematic anticoagulation therapy post-TAVR would reduce the incidence of VHD.

  • aortic stenosis
  • transcatheter valve interventions

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Footnotes

  • Contributors Each author has contributed to this work as follows: MDT, PP, JR-C: conception and design, and interpretation of data; drafting and revising of manuscript; final approval of the manuscript submitted. AJM-G, AL, VA, HCW, LN-F, ANC, EG, VS, JK, IJA-S, LMB, FL, AM, HLB, PJ-Q, BGdB, AD, OA-JA and RP: critical review of the manuscript for important intellectual content; final approval of the manuscript submitted.

  • Funding MDT and OA-JA were supported by a research PhD grant from the Fundacion Alfonso Martin Escudero (Spain). JR-C holds the Canadian Research Chair ‘Fondation Famille Jacques Larivière’ for the Development of Structural Heart Disease Interventions.

  • Competing interests PP has Core Lab contracts with Edwards Lifesciences for which he receives no direct compensation. R-C has received research grants from Edwards Lifesciences and Medtronic.

  • Patient consent Obtained.

  • Ethics approval The study was performed in accordance with the institutional ethics committees.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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