TAVR : nemesis of NOACs?

A. Polzin; C. Helten; Daniel Metzen; S. Zako; V. Veulemans; M. Kelm; T. Zeus

doi:10.1007/s11239-022-02721-6

TAVR : nemesis of NOACs?

A. Polzin, C. Helten, Daniel Metzen, S. Zako, V. Veulemans, M. Kelm, T. Zeus

Western Sydney University

Research output: Contribution to journal › Article › peer-review

Abstract

Data on non-vitamin K antagonist oral anticoagulants (NOACs) in transcatheter aortic valve replacement (TAVR) patients are controversial. In patients without atrial fibrillation (AF), rivaroxaban showed enhanced ischemia and bleeding as compared to standard of care. ENVISAGE showed enhanced bleeding in AF patients as compared to vitamin K antagonist (VKA). Only apixaban was non-inferior but failed superiority regarding bleeding in AF patients after TAVR. One could hypothesize that this might be due to pharmacokinetics of NOACs. Therefore, we compared outcome in rivaroxaban/edoxaban (once-daily) and apixaban (twice-daily) treated patients. 568 patients with indication for permanent oral anticoagulation due to AF undergoing TAVR were analyzed via inverse probability of treatment weighting. Valve academic research consortium complications during 30-day follow-up were assessed. Bleeding complications were similar in once-daily and twice-daily NOACs (major: 22 (7.5%) vs. 14 (5.3%), p = 0.285; minor: 66 (22.4%) vs. 46 (17.4%), p = 0.133). Complications did not change when splitting the cohort in the different agents apixaban, rivaroxaban and edoxaban. These findings remained robust after multivariate analysis. In summary, twice-daily and once-daily NOACs did not differ regarding bleeding complications in a hypothesis generating real-world cohort of TAVR patients with AF.

Original language	English
Pages (from-to)	181-184
Number of pages	4
Journal	Journal of Thrombosis and Thrombolysis
Volume	55
Issue number	1
DOIs	https://doi.org/10.1007/s11239-022-02721-6
Publication status	Published - Jan 2023

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10.1007/s11239-022-02721-6

Cite this

@article{fe0f7653286c498a93d7357af81d019c,

title = "TAVR : nemesis of NOACs?",

abstract = "Data on non-vitamin K antagonist oral anticoagulants (NOACs) in transcatheter aortic valve replacement (TAVR) patients are controversial. In patients without atrial fibrillation (AF), rivaroxaban showed enhanced ischemia and bleeding as compared to standard of care. ENVISAGE showed enhanced bleeding in AF patients as compared to vitamin K antagonist (VKA). Only apixaban was non-inferior but failed superiority regarding bleeding in AF patients after TAVR. One could hypothesize that this might be due to pharmacokinetics of NOACs. Therefore, we compared outcome in rivaroxaban/edoxaban (once-daily) and apixaban (twice-daily) treated patients. 568 patients with indication for permanent oral anticoagulation due to AF undergoing TAVR were analyzed via inverse probability of treatment weighting. Valve academic research consortium complications during 30-day follow-up were assessed. Bleeding complications were similar in once-daily and twice-daily NOACs (major: 22 (7.5%) vs. 14 (5.3%), p = 0.285; minor: 66 (22.4%) vs. 46 (17.4%), p = 0.133). Complications did not change when splitting the cohort in the different agents apixaban, rivaroxaban and edoxaban. These findings remained robust after multivariate analysis. In summary, twice-daily and once-daily NOACs did not differ regarding bleeding complications in a hypothesis generating real-world cohort of TAVR patients with AF.",

author = "A. Polzin and C. Helten and Daniel Metzen and S. Zako and V. Veulemans and M. Kelm and T. Zeus",

year = "2023",

month = jan,

doi = "10.1007/s11239-022-02721-6",

language = "English",

volume = "55",

pages = "181--184",

journal = "Journal of Thrombosis and Thrombolysis",

issn = "0929-5305",