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Vitamin-K antagonists versus Non-vitamin K oral anticoagulants in elderly patients with severe aortic stenosis and atrial fibrillation
Session:
Posters (Sessão 6 - Écran 3) - Arrítmias 7 - Fibrilhação Auricular 2
Speaker:
João Calvão
Congress:
CPC 2022
Topic:
C. Arrhythmias and Device Therapy
Theme:
05. Atrial Fibrillation
Subtheme:
05.5 Atrial Fibrillation - Stroke Prevention
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
João Calvão; Ana Filipa Amador; Catarina Martins da Costa; Carlos Xavier Resende; Pedro Grilo Diogo; Tânia Proença; Ricardo Alves Pinto; Miguel Martins de Carvalho; André Cabrita; Catarina Amaral Marques; Cátia Oliveira; Luis Daniel Santos; Mariana Vasconcelos; João Freitas; Filipe Macedo
Abstract
<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Background</strong>: Data comparing Non-vitamin K oral anticoagulants (NOAC) to Vitamin-K antagonists (VKA) in patients with severe aortic stenosis (AS) and atrial fibrillation (AF) are limited. Guideline recommendations on the use of NOAC in these patients are based on studies including a low number of patients with severe AS. Elderly patients with AS represent a particular subgroup with high thromboembolic and hemorrhagic risk.</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Purpose</strong>: To compare the effect of NOAC versus VKA on the presence of left atrial appendage (LAA) thrombus among elderly patients with AF and severe AS.</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods</strong>: In this retrospective study, we identified 315 patients ≥70 years with severe aortic stenosis who were proposed for transcatheter aortic valve implantation (TAVI) in our center between January 2014 and December 2019. Among this cohort, 79 (25.1%) patients had history of AF. We analyzed the association between the type of anticoagulation used (NOAC versus VKA) and the presence of LAA thrombus in the preprocedural cardiac computed tomography scan.</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results</strong>: Of the 79 patients included, 40 (50.6%) were anticoagulated with VKA and 39 (49.4%) with NOAC. The prevalence of LAA thrombus was similar in both groups (37.5% in the VKA group and 41.0% in the NOAC group, p=0.75), as was the incidence of ischemic stroke (5.0 vs 5.2%, p=0.51) and death (2.6 vs 2.6%, p=0.75) during hospitalization. At 1-year follow-up, the cumulative incidence of ischemic stroke was 11.1% among the population studied (8.5% and 14.7% in the VKA and NOAC group, respectively; p= 0.48).</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusion</strong>: Elderly patients with severe AS and AF who are proposed for TAVI have a high prevalence of LAA thrombus despite anticoagulation. No significant difference in this prevalence was seen in patients anticoagulated with VKA or NOAC. These patients have a similar high incidence of ischemic stroke at 1 year. Further studies are needed in order to better characterize the safety and efficacy of NOAC in this patient population.</span></span></p>
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