Cardiology • Research

Anticoagulant Therapy After TMVR: DOACs vs. VKAs in Bleeding and Thrombotic Events

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Article Impact Level: HIGH
Data Quality: STRONG
Summary of Journal of the American College of Cardiology, 83(2), 334–346. https://doi.org/10.1016/j.jacc.2023.10.031
Dr. Nathan El Bèze et al.

Points

  • Comparison of anticoagulant treatments (DOACs vs. VKAs) in patients undergoing transcatheter mitral valve replacement (TMVR)
  • The study enrolled 156 consecutive TMVR patients, with VKAs predominantly used until October 2019, after which DOACs were prescribed.
  • DOAC treatment is associated with a significantly lower risk of bleeding complications compared to VKAs (adjusted HR: 0.21; 95% CI: 0.06-0.74; P = 0.02)
  • Patients receiving DOACs experienced a shorter length of hospital stay.
  • No significant differences were observed in thrombotic events, major vascular complications, stroke, or death between DOAC and VKA groups.

Summary

The research aimed to compare bleeding and thrombotic events associated with direct oral anticoagulants (DOACs) or vitamin K antagonists (VKAs) in a prospective cohort of patients who underwent transcatheter mitral valve replacement (TMVR). The study enrolled 156 consecutive patients who underwent transseptal TMVR using a SAPIEN family prosthesis at a single center between 2011 and 2023. The primary outcome assessed was the occurrence of bleeding, with VKAs being predominantly administered to patients until October 2019, after which DOACs were prescribed. The median follow-up duration was 4.7 months.

The results indicated that the primary outcome, bleeding, was observed in 40% of patients in the VKA group and 9% in the DOAC group. After adjusting for confounding factors, the use of DOACs was associated with a significantly lower risk of bleeding complications compared to VKAs (adjusted HR: 0.21; 95% CI: 0.06-0.74; P = 0.02). Additionally, treatment with DOACs was linked to a shorter hospital stay. Notably, no significant differences were found in terms of thrombotic events, major vascular complications, stroke, or death between the two anticoagulant groups.

In conclusion, the findings suggest that using DOACs after TMVR, as opposed to VKAs, may reduce the risk of bleeding complications and lead to a shorter hospital stay for patients without a significant increase in the risk of thrombotic events. These results provide valuable insights into the potential benefits of DOACs in antithrombotic treatment following TMVR.

Link to the article: https://www.sciencedirect.com/science/article/abs/pii/S0735109723080166

References

El Bèze, N., Himbert, D., Suc, G., Brochet, E., Ajzenberg, N., Cailliau, A., Kikoïne, J., Delhomme, C., Carrasco, J. L., Ou, P., Iung, B., & Urena, M. (2024). Comparison of Direct Oral Anticoagulants vs Vitamin K Antagonists After Transcatheter Mitral Valve Replacement. Journal of the American College of Cardiology, 83(2), 334–346. https://doi.org/10.1016/j.jacc.2023.10.031

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