No reason to quit: TAVR patients can continue anticoagulation therapy throughout procedure
Continuing oral anticoagulation therapy throughout transcatheter aortic valve replacement (TAVR) appears to be safe for patients, according to a new study published in JACC: Cardiovascular Interventions.
Many TAVR patients are already taking an anticoagulation medication—either a vitamin K antagonist or a direct-acting oral anticoagulant (DOAC)—at the time of the procedure. Those patients are typically asked to temporarily stop anticoagulation therapy two to four days before they undergo TAVR, but this study’s authors aimed to see if this was truly necessary.
“Because the number of TAVR patients is expected to grow in parallel to changing demographics and a broader indication for TAVR in the future, simplification of the peri-procedural management of such patients is of great interest,” wrote lead author Miriam Brinkert, MD, of Heart Center Lucerne in Switzerland, and colleagues.
Brinkert et al. tracked more than 550 patients who continued anticoagulation therapy during TAVR and more than 700 patients who interrupted their anticoagulation therapy. All patients received care at one of give high-volume facilities in Europe, and the average age was 82 years old. While 95% of patients were on anticoagulation therapy due to concerns related to atrial fibrillation, another 3% were on it for prior deep vein thrombosis.
Patients continuing anticoagulation therapy with a DOAC did still skip taking the DOAC on the morning of the procedure. The care teams administered intravenous heparin, and protamine, as needed.
Overall, after 30 days of follow-up, the authors found that bleeding complication rates were similar between the two patient groups. The rate of major or life-threatening bleeding events, for example, was 11.3% for patients who continued anticoagulation therapy and 14.3% for patients who interrupted their anticoagulation therapy. The rate of major vascular complications was 11% for the continued anticoagulation group and 12.3% for patients the interrupted anticoagulation group.
In addition, the authors added, Kaplan-Meier estimates of patient survival after 30 days were 97.6% for the continued anticoagulation group and 97.1% for the interrupted anticoagulation group. Survival estimates for one year after the procedure were 85.3% for the continued anticoagulation group and 84% for the interrupted anticoagulation group.
Another key finding was related to each patient’s risk of stroke—a subject that was not even a primary focus of the team’s analysis.
“Although this trial was not powered to detect differences in stroke rates, we did observe a trend toward a lower peri-procedural stroke rate in patients with continuation of anticoagulation,” the authors wrote. “Studying a larger sample size with randomization of patients could possibly show whether these explorative findings can be confirmed in a prospective, pre-specified approach.”
The full study can be read here.
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