Τίτλος:
Comparison of warfarin versus DOACs in patients with concomitant indication for oral anticoagulation undergoing TAVI; results from the ATLAS registry
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
The optimal antithrombotic therapy for patients undergoing TAVI with concomitant indication for oral anticoagulation remains unclear. In this high-risk population group, there is a paucity of data with regards to the use of DOACs. In the present study we compared long-term clinical outcomes of TAVI patients requiring anticoagulation, treated with warfarin versus DOACs. Consecutive patients, who underwent TAVI with indication for oral anticoagulation from the multicenter ATLAS registry were studied and divided in two groups depending on the chosen anticoagulation regimen, warfarin vs. DOACs. 30-day survival, as well as estimated 1 and 2-year all-cause mortality were compared between groups. The secondary endpoint included in-hospital major or life-threatening bleeding. The study group included 217 patients (102 treated with warfarin; 115 treated with DOACs). Kaplan–Meier estimated survival was found to be statistically similar in the warfarin and DOAC groups (90.6% vs. 93.7% for 1-year and 84.5% vs. 88.5%, for 2-year survival, respectively, Plog-rank = 0.984). Adjusted hazard ratio for all cause mortality was similar between the two groups (HRwarfarin vs. DOAC = 1.15; 95% CI 0.33 to 4.04, p = 0.829). Propensity matching revealed similar results. At 30-days, all-cause mortality was found to be comparable between the two groups. With regards to BARC defined bleeding complications, major and life-threatening complications did not differ between the two anticoagulation groups (6% vs. 8% for warfarin and DOACs respectively, p = 0.857). DOACs seem to demonstrate a similar safety and efficacy profile compared to warfarin in TAVI patients with a concomitant indication for oral anticoagulation. © 2019, Springer Science+Business Media, LLC, part of Springer Nature.
Συγγραφείς:
Kalogeras, K.
Jabbour, R.J.
Ruparelia, N.
Watson, S.
Kabir, T.
Naganuma, T.
Vavuranakis, M.
Nakamura, S.
Malik, I.S.
Mikhail, G.
Dalby, M.
Panoulas, V.
Περιοδικό:
Journal of Thrombosis and Thrombolysis
Λέξεις-κλειδιά:
apixaban; dabigatran; edoxaban; rivaroxaban; warfarin; anticoagulant agent; blood clotting factor 10a inhibitor; warfarin, aged; all cause mortality; anticoagulant therapy; aortic stenosis; Article; bleeding; clinical outcome; cohort analysis; controlled study; disease registry; drug efficacy; drug indication; drug safety; female; human; life threat; long term care; major clinical study; male; priority journal; retrospective study; survival analysis; survival time; transcatheter aortic valve implantation; very elderly; adverse drug reaction; adverse event; aortic valve stenosis; bleeding; blood; blood clotting; drug effect; mortality; patient selection; postoperative complication; procedures; prognosis; register; thrombosis; transcatheter aortic valve implantation, Aged, 80 and over; Anticoagulants; Aortic Valve Stenosis; Blood Coagulation; Factor Xa Inhibitors; Female; Hemorrhage; Humans; Long Term Adverse Effects; Male; Patient Selection; Postoperative Complications; Prognosis; Registries; Survival Analysis; Thrombosis; Transcatheter Aortic Valve Replacement; Warfarin
DOI:
10.1007/s11239-019-01968-w
