RT Journal Article
SR Electronic
T1 Impact of anticoagulation therapy on valve haemodynamic deterioration following transcatheter aortic valve replacement
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP 814
OP 820
DO 10.1136/heartjnl-2017-312514
VO 104
IS 10
A1 María Del Trigo
A1 Antonio J Muñoz-García
A1 Azeem Latib
A1 Vincent Auffret
A1 Harindra C Wijeysundera
A1 Luis Nombela-Franco
A1 Enrique Gutierrez
A1 Asim N Cheema
A1 Vicenç Serra
A1 Ignacio J Amat-Santos
A1 Joelle Kefer
A1 Luis Miguel Benitez
A1 Florence Leclercq
A1 Antonio Mangieri
A1 Hervé Le Breton
A1 Pilar Jiménez-Quevedo
A1 Bruno Garcia del Blanco
A1 Antonio Dager
A1 Omar Abdul-Jawad Altisent
A1 Rishi Puri
A1 Philippe Pibarot
A1 Josep Rodés-Cabau
YR 2018
UL http://heart.bmj.com/content/104/10/814.abstract
AB 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.