Clin Res Cardiol (2023). https://doi.org/10.1007/s00392-023-02180-w
Direct oral anticoagulants versus vitamin K antagonists in patients after transcatheter aortic valve implantation: results from 16,974 patients of the German Aortic Valve Registry (GARY)
C. Hohmann1, R. Pfister1, C. Frerker2, A. Beckmann3, T. Walther4, S. Bleiziffer5, S. Ensminger6, R. Bekeredjian7, M. Seiffert8, J.-M. Sinning9, H. Möllmann10, F. Beyersdorf11, S. Baldus12, A. Böning13, E. Herrmann14, Ü. Balaban14, E. Kuhn15, für die Studiengruppe: GARY
1Klinik III für Innere Medizin, Herzzentrum der Universität zu Köln, Köln; 2Medizinische Klinik II / Kardiologie, Angiologie, Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Lübeck; 3Klinik für Thorax- und Kardiovaskularchirurgie, Herzzentrum Duisburg, Duisburg; 4Klinik für Thorax-, Herz- und Thorakale Gefäßchirurgie, Universitätsklinikum Frankfurt, Frankfurt am Main; 5Klinik für Thorax- und Kardiovaskularchirurgie, Herz- und Diabeteszentrum NRW, Bad Oeynhausen; 6Klinik für Herz- und thorakale Gefäßchirurgie, Universitätsklinikum Schleswig-Holstein, Lübeck; 7Kardiologie und Angiologie, Robert-Bosch-Krankenhaus, Stuttgart; 8Klinik für Kardiologie, Universitäres Herz- und Gefäßzentrum Hamburg, Hamburg; 9Innere Medizin III - Kardiologie, St. Vinzenz-Hospital, Köln; 10Klinik für Innere Medizin I, Kath. St. Paulus Gesellschaft, Dortmund; 11Klinik für Herz- und Gefäßchirurgie, Universitäts-Herzzentrum Freiburg - Bad Krozingen, Freiburg im Breisgau; 12Klinik für Kardiologie, Angiologie, Pneumologie und Internistische Intensivmedizin, Herzzentrum der Universität zu Köln, Köln; 13Klinik für Herz-, Kinderherz- und Gefäßchirurgie, Universitätsklinikum Gießen und Marburg GmbH, Gießen; 14Universitätsklinikum Frankfurt, Frankfurt am Main; 15Klinik für Herzchirurgie, herzchirurgische Intensivmedizin und Thoraxchirurgie, Universitätsklinikum Köln, Köln;

Background

Nowadays transcatheter aortic valve implantation (TAVI) is one of the therapies of choice for patients with symptomatic severe aortic stenosis. However, the regime of anticoagulant therapy in patients with additional indication for oral anticoagulation still remains a matter of debate. This study investigates the efficacy of direct oral anticoagulants (DOAC) versus vitamin K antagonists (VKA) in patients after TAVI in a real-world population.

Methods

The German Aortic Valve Registry (GARY) is a prospective, multicenter all-comers registry enrolling patients undergoing invasive treatment for aortic valve disease. From January 2011 to December 2019, 141,790 patients from 92 hospitals in Germany were enrolled. Anticoagulatory treatment regimens and types of oral anticoagulants were assessed at hospital discharge for patients after TAVI procedures. All-cause mortality and the combined endpoint “cardiac and cerebrovascular events” containing myocardial infarction (MI), stroke, transient ischaemic attack (TIA), aortic prosthesis re-intervention and all-cause mortality in the first year after TAVI were examined by treatment regimen.

Results

Of 45,598 patients undergoing TAVI, 16,974 patients (37.2 %) received an anticoagulant regimen that included VKA or DOAC. Hereof, the majority of patients were prescribed VKA (n = 11,333, 66.8 %) compared to DOAC (n = 5,641, 33.2 %) with an increase of DOAC use from 9.4 % in 2011 to 69.9 % in 2019. After adjustment for baseline confounders, all-cause mortality (HR 0.99, 95% CI 0.89-1.10, p = 0.81) and cardiac and cerebrovascular events (HR 1.07, 95% CI 0.97-1.18, p = 0.17) did not differ significantly between VKA and DOAC groups.

Conclusions

In an analysis from one of the world’s largest national patient registries undergoing TAVI, we found continuously increasing rates of DOAC use over time. 1-year risk of all-cause mortality and cardiac and cerebrovascular events were comparable between patients on VKA or DOAC therapy, in this sub-population of GARY.
https://dgk.org/kongress_programme/jt2023/aV5.html