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Oral Anticoagulation after Transcatheter Aortic Valve Replacement
Session:
Sessão de Posters 08 - Intervenção estrutural: TAVI
Speaker:
Fernando Lima do Nascimento Ferreira
Congress:
CPC 2024
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
25. Interventional Cardiology
Subtheme:
25.3 Non-coronary Cardiac Intervention
Session Type:
Cartazes
FP Number:
---
Authors:
Fernando Nascimento Ferreira; Ines Rodrigues; Francisco Albuquerque; Miguel Figueiredo; Barbara Teixeira; Francisco Albuquerque; Ricardo Carvalheiro; Tiago Mendonça; Duarte Cacela; Ruben Ramos; António Fiarresga; Rui Cruz Ferreira
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Introduction:</strong> Current European guidelines recommend isolated oral anticoagulation following transcatheter aortic valve replacement (TAVR) in patients (pts) with clinical indication, but the optimal antithrombotic regimen is still a matter of debate.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Objective:</strong> To compare the procedure-related complications and long term outcomes of vitamin K antagonist (VKA) and non-vitamin K oral anticoagulants (NOAC) in pts undergoing TAVR with indication for OAC.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Methodology:</strong> Consecutive pts under OAC with severe aortic stenosis who underwent TAVI between 2018 and 2023 in a single center were included. Two groups were defined based on the anticoagulant class prescribed post-procedure. Peri-procedural safety endpoints and 1-year efficacy endpoints defined by VARC-2 were evaluated according to OAC class and compared using the Chi-square test, Exact Fisher test, Mann-Whitney U test, and independent samples t-test. A p-value < 0.05 was considered statistically significant. </span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Results:</strong> A total of 214 pts undergoing TAVR with indication for anticoagulation post-procedure were included (20 with DOAC and 194 with VKA). The median age was 83 years and 51.4% were male. Patients under VKA were younger (median 83 years (31) vs. 79 years (54), p=0.003), had a higher prevalence of prior valve replacement (6.2% vs. 45%, p=0.001), and higher Euroscore II (median 6.46 (22.9) vs. 3.96 (40.1), p=0.003).</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Regarding procedural safety endpoints, there was no significant differences in the prevalence of life-threatening bleeding or need for transfusional support during hospitalization (p=1.0; p=0.188, respectively). In additions, there was no significant differences in the acute kidney injury (AKI), (AKI equal to or greater than KDIGO2 8.8% (DOAC) vs. 0% (VKA), p=0.525) and in major vascular complications (p=0.609).</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">For long-term endpoints, there were no statistically significant differences in the prevalence of Stroke, re-hospitalization, and mortality at 1 year (p=0.182; p=1.0; p=0.662, respectively). No valve thrombosis was observed in either group. Additionally, the has no statistically significant differences in the prevalence of thromboembolic and hemorrhagic events until end of follow up as well as all-cause mortality (p=0,603; p=1,0; p=1,0, respectively).</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Conclusion:</strong> From the analysis, individuals undergoing anticoagulation with VKA after TAVR, despite being younger, appear to have a higher prevalence of prior valve replacement and a higher surgical risk. However, there were no findings suggestive of higher risk of hemorrhagic and thrombotic complications, as well as higher all-cause mortality in either study group. However, larger-scale studies are needed to corroborate these results.</span></span></span></p>
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