Long-Term Outcomes Following Transcatheter Aortic Valve Replacement as Stratified by Antiplatelet and Anticoagulation Strategy
Presenter
Kris Kumar, DO, MSc, The University of California, San Diego, Portland, OR
Kris Kumar, DO, MSc1, Craig Morris, MD2, Tessa Herman, MD2, Ashraf Samhan, BS2, Trisha Chau, BS2, Scott M Chadderdon, MD2, Gurion Lantz, MD2, Howard K. Song, MD PhD2, Firas E. Zahr, MD, FSCAI3 and Harsh Golwala, MD4, (1)The University of California, San Diego, Portland, OR, (2)Oregon Health & Science University, Portland, OR, (3)OHSU Knight Cardiovascular Institute, Portland, OR, (4)-, Portland, OR
Keywords: Structural Heart Disease (SHD) and TAVI/TAVR/Aortic Valve
Background:
Several antiplatelet/anticoagulation strategies have been utilized in order to decrease risk of valve thrombosis following transcatheter aortic valve replacement (TAVR). We aimed to further elucidate long term outcomes in patients undergoing TAVR stratified by various antiplatelet and anticoagulant strategies at discharge.
Methods:
We performed a retrospective analysis of all patients undergoing TAVR for severe aortic stenosis from July 2012 to June 2020 at Oregon Health & Science University. Descriptive analysis of demographic variables was performed. Patient characteristics were reported as frequencies and percentages for categorical variables and mean with standard deviations for continuous variables. The primary endpoint was all-cause mortality at 1 year. Secondary endpoints included heart failure, stroke and bleeding-related hospitalization within 1-year post TAVR.
Results:
A total of 915 patients met inclusion criteria, with an average age of 78.5 ± 9.8 years (58.7% female). Mean Society of Thoracic Surgeons score was 5.5 ± 3.8. Atrial fibrillation or atrial flutter at the time of TAVR was identified in 28% of the cohort. Discharge antiplatelet/anticoagulation subgroups were dual antiplatelet therapy (DAPT) 67%, direct oral anticoagulant (DOAC) 17% (14% Apixaban and 3% Rivaroxaban), vitamin K antagonist (VKA) 14% and low molecular weight heparin (LMWH) 1%. The overall 1-year mortality of the cohort was 7.2% ± 0.25%. One-year mortality for patients discharged with aspirin and a P2Y12 inhibitor was 6.8%, DOAC 7.7%, VKA 8.8% and 0% for LMWH. There was no significant difference in mortality amongst the different discharge medication strategies at 1-year via one way ANOVA (p=0.841). Within the cohort, the 1-year heart failure hospitalization was 7.9%, stroke was 2.9%, and the rate of bleeding related rehospitalization at 1-year was 3%, driven largely in part by gastrointestinal bleeding (2.7%).
Conclusions:
Our single center analysis demonstrates the long-term outcomes of various antiplatelet/anticoagulation strategies. Higher rates of mortality at one year were observed in patients discharged on either VKA or DOAC versus antiplatelet therapy alone.