Pausing oral anticoagulation during TAVR reduces bleeding risk
It may be beneficial to pause the use of oral anticoagulant (OAC) therapy when patients undergo transcatheter aortic valve replacement (TAVR), according to new data published in The New England Journal of Medicine.[1]
The findings, presented Aug. 31 at ESC Congress 2024, suggest that skipping OAC medications for just a small amount of time could make a big impact.
The POPular PAUSE TAVI trial examined data from more than 800 patients treated with TAVR from November 2020 to December 2023. The mean patient age was 81.1 years old, and 65.5% were men. While 81.9% of patients were being treated with a direct OAC at the time of their procedure, all other patients were on vitamin K antagonists.
Patients were randomized to either temporarily stop taking OAC medications during treatment or continue OAC therapy with no interruption at all. It’s worth noting that patients in the interruption group did not go long without their medications; OAC therapy was continued a median of one day after TAVR.
The study’s primary outcome was a composite of cardiovascular mortality, stroke, myocardial infarction, major vascular complications or major bleeding events within 30 days of TAVR. This was seen in 14.8% of patients in the interruption group and 16.5% of patients in the continuation group. The interruption group was associated with fewer vascular complications (7.7% vs. 10.2%) and major bleeding events (8.9% vs. 11.1%).
Thromboembolic events, meanwhile, were seen at comparable rates among patients in the interruption group and continuation group.
“The optimal strategy for periprocedural anticoagulation management is not well studied in patients undergoing TAVR, who are often relatively elderly and have other health conditions,” first author Dirk Jan van Ginkel, MD, coordinating investigator of POPular PAUSE TAVI and a cardiologist with St. Antonius Hospital in The Netherlands, said in a statement. “Whether OACs should be interrupted in patients with a long-term indication, such as those with atrial fibrillation, was uncertain. Observational evidence suggests that continuation may decrease the risk of thromboembolic events, such as stroke, and does not increase the risk of bleeding. The randomized POPular PAUSE TAVI trial investigated continuing vs. interrupting OACs and in fact, we found the opposite: no sign of a reduction in thromboembolic events and more bleeding in the continued OAC group.”
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Michael has more than 16 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.