Anticoagulation After Surgical or Transcatheter Bioprosthetic Aortic Valve Replacement

Tarun Chakravarty, Akshar Patel, Samir Kapadia, Matthias Raschpichler, Richard W. Smalling, Wilson Y. Szeto, Yigal Abramowitz, Wen Cheng, Pamela S. Douglas, Rebecca T. Hahn, Howard C. Herrmann, Dean Kereiakes, Lars Svensson, Sung Han Yoon, Vasilis C. Babaliaros, Susheel Kodali, Vinod H. Thourani, Maria C. Alu, Yangbo Liu, Thomas McAndrewMichael Mack, Martin B. Leon, Raj R. Makkar

Research output: Contribution to journalArticlepeer-review

32 Scopus citations

Abstract

Background: There is paucity of evidence on the impact of anticoagulation (AC) after bioprosthetic aortic valve replacement (AVR) on valve hemodynamics and clinical outcomes. Objectives: The study aimed to assess the impact of AC after bioprosthetic AVR on valve hemodynamics and clinical outcomes. Methods: Data on antiplatelet and antithrombotic therapy were collected. Echocardiograms were performed at 30 days and 1 year post-AVR. Linear regression model and propensity-score adjusted cox proportional model were used to assess the impact of AC on valve hemodynamics and clinical outcomes, respectively. Results: A total of 4,832 patients undergoing bioprosthetic AVR (transcatheter aortic valve replacement [TAVR], n = 3,889 and surgical AVR [SAVR], n = 943) in the pooled cohort of PARTNER2 (Placement of Aortic Transcatheter Valves) randomized trials and nonrandomized registries were studied. Following adjustment for valve size, annular diameter, atrial fibrillation, and ejection fraction at the time of assessment of hemodynamics, there was no significant difference in aortic valve mean gradients or aortic valve areas between patients discharged on AC vs. those not discharged on AC, for either TAVR or SAVR cohorts. A significantly greater proportion of patients not discharged on AC had an increase in mean gradient >10 mm Hg from 30 days to 1 year, compared with those discharged on AC (2.3% vs. 1.1%, p = 0.03). There was no independent association between AC after TAVR and adverse outcomes (death, p = 0.15; rehospitalization, p = 0.16), whereas AC after SAVR was associated with significantly fewer strokes (hazard ratio [HR]: 0.17; 95% confidence interval [CI]: 0.05–0.60; p = 0.006). Conclusions: In the short term, early AC after bioprosthetic AVR did not result in adverse clinical events, did not significantly affect aortic valve hemodynamics (aortic valve gradients or area), and was associated with decreased rates of stroke after SAVR (but not after TAVR). Whether early AC after bioprosthetic AVR has impact on long-term outcomes remains to be determined.

Original languageEnglish
Pages (from-to)1190-1200
Number of pages11
JournalJournal of the American College of Cardiology
Volume74
Issue number9
DOIs
StatePublished - 3 Sep 2019
Externally publishedYes

Keywords

  • anticoagulation
  • bioprosthetic aortic valve replacement
  • transcatheter aortic valve replacement

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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