Direct oral anticoagulants (DOACs) may be a better treatment option for transcatheter aortic valve replacement (TAVR) patients with atrial fibrillation (AFib) than vitamin K antagonists (VKAs), according to new research published in JACC: Cardiovascular Interventions.
The analysis is based on data from more than 400 patients included in the OCEAN multicenter registry. All patients underwent successful TAVR in Japan from October 2013 to May 2017. While 56.3% of those patients were given DOACs at discharge, the rest were prescribed VKAs. The mean patient age was 84.4 years old, and two-thirds of the patients were women.
Overall, the team found, the DOAC group had an all-cause mortality rate of 10.3%, much lower than than the VKA group’s 23.3%. On the other hand, the two groups had similar rates of long-term bleeding and ischemic events after discharge.
“To our knowledge, our study is the first to demonstrate the long-term efficacy of DOAC therapy compared with VKAs in a large nationwide, unselected cohort of patients with AFib who were successfully discharged after TAVR,” wrote lead author Hideyuki Kawashima, PhD, a cardiologist with Teikyo University School of Medicine in Tokyo, Japan, and colleagues. “After adjusting for comorbidity and concomitant platelet therapy, we found that treatment with DOACs was associated with a lower risk for long-term all-cause mortality compared with VKA. This finding might support the uniform use of DOACs in patients with AFib undergoing TAVR who are indicated for anticoagulation therapy.”
The team noted that one possible explanation for the difference in all-cause mortality rates could be the fact that VKAs were given to patients with advanced chronic kidney disease (CKD). However, CKD was specifically not associated with one treatment option over the other—so this may not be the case.
For now, the authors concluded, additional randomized trials are needed to learn more about the relationship between DOACs, VKAs and TAVR outcomes in patients with AFib.
The full study can be read here.