Alexis Okoh
,
RWJBarnabas Health, Newark, NJ
Setri Fugar, M.D.
,
Rush University Medical Center, Chicago, IL
Amer Hawatmeh, M.D.
,
Newark Beth Israel Medical Center, Woodland Park, NJ
Mohammad Thawabi, M.D.
,
Newark Beth Israel Medical Center, Verona, NJ
Dustin Hanos, MD
,
Newark Beth Israel Medical Center, Chicago, IL
Aakash Garg, MD
,
Newark Beth Israel Medical Center, Newark, NJ
Swaiman Singh, MD
,
Newark Beth Israel Med Ctr Card, Newark, NJ
Komalpreet Arora
,
Newark Beth Israel Medical Center, Chicago, IL
Marc Cohen, M.D.
,
Newark Beth Israel Medical Center, Chicago, IL
Bruce J Haik, M.D.
,
Saint Barnabas Medical Center, West Orange, NJ
Mark J. Russo, M.D.
,
RWJBarnabas Health, Newark, NJ
Background:
The study aims to investigate the role of anticoagulation (AC) with either rivaroxaban or warfarin in stroke prevention among patients with atrial fibrillation (AF) who underwent transcatheter aortic valve replacement (TAVR).
Methods
:
AF patients who had TAVR at a single center between 2012 and 2015 with at least a 36-month follow-up were identified from a prospectively maintained database. Study participants were divided into two groups based on their discharge AC protocol (Rivaroxaban alone/+ASA vs Warfarin alone/+ASA) and matched in a 1:2 fashion via propensity matching. The primary outcome was a composite of stroke and all-cause mortality. Secondary outcomes included bleeding events and readmission within 1-year. KM survival and stratified log rank test was used to estimate and compare the primary outcome in both groups. Cox proportional hazards was used to identify factors associated with all-cause mortality.
Results:
A total of 151 AF patients who had TAVR were discharged home with either rivaraxoban (n=31) or warfarin (n=121). 1:2 propensity matching identified 25 vs 50 patients in each arm. Age (p=0.739), Sex (p=0.743), BMI (0.754), STS score (0.962), Approach (p=0.809) Frailty (p=1.00). After 36 months, incidence of the primary end-point was 36% vs 32%; [HR, 95 C.I: 1.19 (0.54, 2.9, log rank test: p=0.672] and bleeding events were 12% vs. 4% in the warfarin vs. rivaroxaban arms respectively. Readmission within 1-year was similar between both groups (p=0.495). Cox proportional hazards showed only non-transfemoral approach (p=0.006) to be an independent predictor of the primary outcome.
Conclusions:
Anticoagulation with rivaroxaban or warfarin is equally effective in stroke prevention among AF patients who undergo TAVR. Non-transfemoral approach is associated with a high risk of mortality among this patient population.
