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August 27, 2019

Study Published on Anticoagulation After Surgical or Transcatheter Aortic Valve Replacement

August 27, 2019—Findings from a study aimed to assess the impact of anticoagulation after bioprosthetic aortic valve replacement (AVR)—either surgical (SAVR) or transcatheter (TAVR)—on valve hemodynamics and clinical outcomes were published by Tarun Chakravarty, MD, et al in Journal of the American College of Cardiology (JACC) (2019;74:1190–1200).

As summarized in JACC, the investigators collected data on antiplatelet and antithrombotic therapy and performed echocardiograms at 30 days and 1 year post AVR. Linear regression model and propensity-score adjusted cox proportional model were used to assess the impact of anticoagulation on valve hemodynamics and clinical outcomes, respectively. The study was composed of a total of 4,832 patients undergoing bioprosthetic AVR (TAVR, n = 3,889; SAVR, n = 943) in the pooled cohort of PARTNER II randomized trials and nonrandomized registries.

The investigators found the following after adjusting for valve size, annular diameter, atrial fibrillation, and ejection fraction at the time of assessment of hemodynamics:

  • There was no significant difference in aortic valve mean gradients or aortic valve areas between patients discharged on anticoagulants versus those patients not discharged on anticoagulation, for either TAVR or SAVR cohorts.
  • A significantly greater proportion of patients not discharged on anticoagulants had an increase in mean gradient > 10 mm Hg from 30 days to 1 year compared with those who were discharged on anticoagulation (2.3% vs 1.1%, P = .03).
  • There was no independent association between anticoagulation after TAVR and adverse outcomes (death, P = .15; rehospitalization, P = .16), whereas anticoagulation after SAVR was associated with significantly fewer strokes (hazard ratio, 0.17; 95% confidence interval, 0.05–0.6; P = .006).

The investigators concluded that in the short term, early anticoagulation after bioprosthetic AVR did not result in adverse clinical events, did not significantly affect aortic valve hemodynamics (aortic valve gradients or area), and was associated with decreased rates of stroke after SAVR (but not after TAVR). Whether early anticoagulation after bioprosthetic AVR has an impact on long-term outcomes remains to be determined, advised the investigators in JACC.

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