OR03-4
Intermediate Survival of Patients With Pre-Existing or New Onset Atrial Fibrillation Following Transcatheter Aortic Valve Replacement Treated With Direct Oral Anticoagulants Versus Warfarin
Presenter
Eduardo Javier Perez, MD, Hartford HealthCare Hospital, Hartford, CT
Eduardo Javier Perez, MD1, Bryan Piccirillo2, Haris Patail1, Alok Vakil3, Julian Kaufmann4, Jawad Haider1, David Lorenz1, Nicole Hoover1, Mohiudin Cheema1, Christopher Kulman1, Jeffrey Mather1, Sabet Hashim1 and Raymond G. Mckay, M.D., FSCAI1, (1)Hartford HealthCare Hospital, Hartford, CT, (2)Hartford HealthCare Hospital, West Hartford, CT, (3)University of Connecticut, Hartford, CT, (4)University of Connecticut Health, Hartford, CT
Keywords: Pharmacotherapy, Structural Heart Disease (SHD) and TAVI/TAVR/Aortic Valve
Background:
Prior reports on direct oral anticoagulants (DOAC) versus Warfarin for the treatment of pre-existing or new onset atrial fibrillation (AF) following transcatheter aortic valve replacement (TAVR) have presented conflicting survival results
Methods:
We compared in-hospital and 2-year outcomes in 576 AF TAVR patients who were discharged alive and were treated either with DOACs (n=412) or Warfarin (n=164). All patients had either pre-existing (n=561 (97.4%)) or new onset (n=15 (2.6 %)) AF. Propensity matching was used for comparison
Results:
Matched DOAC (n=322) and Warfarin (n=161) patients had similar baseline demographics, cardiovascular risk factors, comorbidities, STS Risk Score, femoral versus alternative vascular access, and use of balloon-expandable versus self-expanding TAVR valves.
In-hospital outcomes for DOAC versus Warfarin cohorts did not differ with respect to ischemic stroke (1.6 vs 1.2%, p=0.788), major vascular complications (1.6 vs 3.7%, p= 0.131), composite bleeding (2.8 vs 5.6%, p=0.126), and pacemaker implantation (17.1 vs 11.8%, p=0.129), although Warfarin patients had a longer postoperative length of stay (2.4 ± 2.4 vs 4.1 ± 3.8 days, p<0.001). At 2-years, Warfarin patients had increased all-cause mortality (HR 1.64, 95% CI 1.05-2.55, p=0.027). However, DOAC versus Warfarin patients did not differ with respect to late stroke (1.2 vs 1.2%, p=1.00) or major bleeding (1.6 vs 3.7%, p=0.131).
Conclusions:
In comparison to warfarin, DOAC therapy for TAVR AF is associated with improved survival without significant differences in stroke or major bleeding at 2-yr follow-up. 