TAVR Patients Requiring Anticoagulation: Direct Oral Anticoagulant or Vitamin K Antagonist?
2 CHU Toulouse - Centre Hospitalier Universitaire de Toulouse
3 LTSI - Laboratoire Traitement du Signal et de l'Image
4 EnVI - Endothélium, valvulopathies et insuffisance cardiaque
5 CHU Rouen
6 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Pontchaillou]
7 CHU Nîmes - Centre Hospitalier Universitaire de Nîmes
8 UM - Université de Montpellier
9 PLF - Polyclinique Les Fleurs - ELSAN
10 ICAN - Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases
11 Institut de cardiologie [CHU Pitié-Salpêtrière]
12 TIMONE - Hôpital de la Timone [CHU - APHM]
13 Clinique Pasteur [Toulouse]
14 Service de chirurgie thoracique cardiaque et vasculaire [Rennes] = Thoracic and Cardiovascular Surgery [Rennes]
15 Hôpital Saint-Joseph [Marseille]
16 SU - Sorbonne Université
17 CHU Henri Mondor [Créteil]
18 AP-HP - Hôpital Bichat - Claude Bernard [Paris]
19 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]
20 IGH - Institut de génétique humaine
21 CHRU Lille - Centre Hospitalier Régional Universitaire [CHU Lille]
22 Service d'Oto-Rhino-Laryngologie (O.R.L.) et de Chirurgie Cervico-Faciale [CHU Caen]
23 NCT+ - Nouvelle Clinique de Tours Saint Gatien-Alliance [Tours]
24 CarMeN - Cardiovasculaire, métabolisme, diabétologie et nutrition
25 CHU Bordeaux - Centre Hospitalier Universitaire de Bordeaux
26 PCVP / CARDIO - Marqueurs pronostiques et facteurs de régulations des pathologies cardiaques et vasculaires - UFC ( UR 3920)
27 CCML - Centre Chirurgical Marie Lannelongue
28 CHU Nantes - Centre Hospitalier Universitaire de Nantes = Nantes University Hospital
29 MPIC - Max Planck Institute for Chemistry
30 CHU Angers - Centre Hospitalier Universitaire d'Angers
31 Hôpital privé de Parly 2 - Ramsay Santé [Le Chesnay-Rocquencourt]
32 CHU Clermont-Ferrand
33 CHU Strasbourg - Centre Hospitalier Universitaire [Strasbourg]
34 MLV - Médipôle Lyon-Villeurbanne
35 CHU Pitié-Salpêtrière [AP-HP]
36 Hôpital privé de Bois-Bernard - Ramsay Santé [Bois-Bernard]
37 CIPL - Clinique de l'Infirmerie Protestante de Lyon
38 CCTM - Centre Cardio-Thoracique de Monaco
39 C2VN - Centre recherche en CardioVasculaire et Nutrition = Center for CardioVascular and Nutrition research
40 CHUGA - CHU de Grenoble-Alpes - Centre Hospitalier Universitaire CHU Grenoble
41 Service de cardiologie [CHU Bichat]
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Résumé
Objectives: Using French transcatheter aortic valve replacement (TAVR) registries linked with the nationwide administrative databases, the study compared the rates of long-term mortality, bleeding, and ischemic events after TAVR in patients requiring oral anticoagulation with direct oral anticoagulants (DOACs) or vitamin K antagonists (VKAs). Background: The choice of optimal drug for anticoagulation after TAVR remains debated. Methods: Data from the France-TAVI and FRANCE-2 registries were linked to the French national health single-payer claims database, from 2010 to 2017. Propensity score matching was used to reduce treatment-selection bias. Two primary endpoints were death from any cause (efficacy) and major bleeding (safety). Results: A total of 24,581 patients who underwent TAVR were included and 8,962 (36.4%) were treated with OAC. Among anticoagulated patients, 2,180 (24.3%) were on DOACs. After propensity matching, at 3 years, mortality (hazard ratio [HR]: 1.37; 95% confidence interval [CI]: 1.12-1.67; P < 0.005) and major bleeding including hemorrhagic stroke (HR: 1.64; 95% CI: 1.17-2.29; P < 0.005) were lower in patients on DOACs compared with those on VKAs. The rates of ischemic stroke (HR: 1.32; 95% CI: 0.81-2.15; P = 0.27) and acute coronary syndrome (HR: 1.17; 95% CI: 0.68-1.99; P = 0.57) did not differ among groups. Conclusions: In these large multicenter French TAVR registries with an exhaustive clinical follow-up, the long-term mortality and major bleeding were lower with DOACs than VKAs at discharge. The present study supports preferential use of DOACs rather than VKAs in patients requiring oral anticoagulation therapy after TAVR.