DOACs Versus VKAs After TAVR Surgery

In a recent analysis, researchers compared the safety and efficacy of direct oral anticoagulants (DOACs) and vitamin K antagonists (VKAs) for managing atrial fibrillation after transcatheter aortic valve replacement (TAVR) surgery. According to the study’s lead author, Federico Oliveri, and colleagues, DOAC-based anticoagulation strategies were advantaged compared with VKAs. The findings were presented in the International Journal of Cardiology.

This meta-analysis included 10 observational studies and 2 randomized controlled trials published to the PubMed, Medline, and Embase databases. The total pooled cohort consisted of 29,485 patients who underwent TAVR and had concomitant indications for oral anticoagulation for atrial fibrillation or deep vein thromboembolism management.

DOACs Appear Slightly Advantaged over VKAs

According to the researchers, DOAC administration after TAVR was associated with a modestly but still significantly lower rate of all-cause mortality (risk ratio [RR], 0.90; 95% confidence interval [CI], 0.81–0.99; P=.04) compared with VKAs, based primarily on data from the observational studies.

The investigators also reported that VKAs and DOACs were comparable for the following outcomes:

  • Cardiovascular mortality (RR, 1.03; 95% CI, 0.81–1.30; P=.84)
  • Total stroke events (RR, 0.97; 95% CI, 0.76–1.23; P=.79)
  • Major/life-threatening bleeding (RR, 0.93; 95% CI, 0.72–1.21; P=.61)
  • Minor bleeding (RR, 0.96; 95% CI, 0.74–1.23; P=.72)

Overall, the authors suggested that DOACs may be the optimal anticoagulation strategy, with slight benefits compared to VKAs, in patients who undergo TAVR with concomitant indications.

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