DOACs outperform VKAs when TAVR patients require oral anticoagulation

Direct oral anticoagulants (DOACs) may be a more effective treatment option than vitamin K antagonists (VKAs) for transcatheter aortic valve replacement (TAVR) patients requiring oral anticoagulation, according to new data published in JACC: Cardiovascular Interventions.

“Despite the risk of bleeding, oral anticoagulation is recommended to reduce the risk of stroke in TAVR patients with atrial fibrillation (AFib),” wrote Romain Didier, MD, PhD, a cardiologist at Brest University Hospital in France, and colleagues. “In this setting, the choice between VKAs and DOACs is still a matter of debate because only relatively small observational studies are available and led to conflicting findings. In the most recent guidelines, the use of VKA is favored in patients with AFib in the first three months after TAVR.”

Hoping to shed new light on the debate between DOACs and VKAs, Didier et al. examined data from more than 24,000 TAVR patients treated in French TAVR centers from 2010 to 2017. All data came from the FRANCE-2 and France-TAVI registries.

Overall, more than 36% of TAVR patients required oral anticoagulation. More than 24% of those patients were treated with DOACs, and the remaining patients received VKAs.

After three years, DOACs were associated with lower rates of mortality and major bleeding, including hemorrhagic stroke, compared to VKAs. The rates of ischemic stroke and acute coronary syndrome, meanwhile, was similar between the two groups.

“This large nationwide analysis further confirms the increased risk of bleeding and mortality in TAVR patients when they need to be treated with oral anticoagulation,” the authors wrote. When oral anticoagulation is indicated, DOACs are associated with improved survival and lower incidence of bleeding compared with VKAs.”

These findings do need to be confirmed in large randomized trials, the team added, before they are used to guide specific treatment decisions.

Read the full study here.

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