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11.04.2018 | Original Paper

NOAC monotherapy in patients with concomitant indications for oral anticoagulation undergoing transcatheter aortic valve implantation

verfasst von: Nicolas A. Geis, Christina Kiriakou, Emmanuel Chorianopoulos, Lorenz Uhlmann, Hugo A. Katus, Raffi Bekeredjian

Erschienen in: Clinical Research in Cardiology | Ausgabe 9/2018

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Abstract

Aims

Antithrombotic therapy after transcatheter aortic valve implantation (TAVI) is highly controversial and guideline recommendations are not evidence based. We assessed efficacy and safety of non-vitamin K antagonist oral anticoagulant (NOAC) monotherapy in patients with concomitant indications for OAC undergoing TAVI.

Methods

Among more than 1300 TAVI patients since 2008, 154 patients were identified who received postinterventional NOAC monotherapy. Outcomes were compared to 172 patients treated with vitamin K antagonist (VKA) monotherapy. Thromboembolic as well as bleeding complications were analysed for 6 months after TAVI.

Results

Despite high CHA₂DS₂-Vasc (4.6 ± 1.2), HEMORR₂HAGES (4.7 ± 1.9) and HASBLED (2.7 ± 0.8) scores only three major/life-threatening bleedings and four thromboembolic events occurred after NOAC therapy had been initiated post-TAVI. 12 patients (7.8%) died within 6 months after the procedure. Compared to patients being treated with VKA monotherapy, analysis of a combined end-point of post-procedural death, stroke, embolism and severe bleeding revealed no significant differences (17/154 vs. 14/172; p = 0.45).

Conclusions

The results of this study suggest that NOAC therapy without additional antiplatelet treatment is effective and safe in patients with concomitant indications for OAC undergoing TAVI.

Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP 3rd, Guyton RA, O’Gara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM 3rd, Thomas JD; ACC/AHA Task Force Members (2014) 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 129:2440–2492. https://doi.org/10.1161/CIR.0000000000000029 CrossRefPubMed

Geis NA, Kiriakou C, Chorianopoulos E, Pleger ST, Katus HA, Bekeredjian R (2017) Feasibility and safety of Vitamin K antagonist mono therapy in atrial fibrillation patients undergoing transcatheter aortic valve implantation. EuroIntervention 12:2058–2066. https://doi.org/10.4244/EIJ-D-15-00259 CrossRefPubMed

Ruff CT, Giugliano RP, Braunwald E, Hoffman EB, Deenadayalu N, Ezekowitz MD, Camm AJ, Weitz JI, Lewis BS, Parkhomenko A, Yamashita T, Antman EM (2014) Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials. Lancet 383:955–962. https://doi.org/10.1016/S0140-6736(13)62343-0 CrossRefPubMed

Akin M, Schäfer A, Akin I, Widder J, Brehm M (2015) Use of new oral anticoagulants in the treatment of venous thromboembolism and thrombotic prophylaxis. Cardiovasc Hematol Disord Drug Targets 15:92–96CrossRefPubMed

Hull RD, Gersh MH (2015) The current landscape of treatment options for venous thromboembolism: a focus on novel oral anticoagulants. Curr Med Res Opin 31:197–210. https://doi.org/10.1185/03007995.2014.975786 CrossRefPubMed

Eikelboom JW, Connolly SJ, Brueckmann M, Granger CB, Kappetein AP, Mack MJ, Blatchford J, Devenny K, Friedman J, Guiver K, Harper R, Khder Y, Lobmeyer MT, Maas H, Voigt JU, Simoons ML, Van de Werf F, RE-ALIGN Investigators (2013) Dabigatran versus warfarin in patients with mechanical heart valves. N Engl J Med 369:1206–1214. https://doi.org/10.1056/NEJMoa1300615 CrossRefPubMed

Yadlapati A, Groh C, Malaisrie SC, Gajjar M, Kruse J, Meyers S, Passman R (2016) Efficacy and safety of novel oral anticoagulants in patients with bioprosthetic valves. Clin Res Cardiol 105:268–272. https://doi.org/10.1007/s00392-015-0919-z CrossRefPubMed

Kappetein AP, Head SJ, Généreux P, Piazza N, van Mieghem NM, Blackstone EH, Brott TG, Cohen DJ, Cutlip DE, van Es GA, Hahn RT, Kirtane AJ, Krucoff MW, Kodali S, Mack MJ, Mehran R, Rodés-Cabau J, Vranckx P, Webb JG, Windecker S, Serruys PW, Leon MB, Valve Academic Research Consortium-2 (2012) Updated standardized endpoint definitions for transcatheter aortic valve implantation: the Valve Academic Research Consortium-2 consensus document. EuroIntervention 8:782–795. https://doi.org/10.4244/EIJV8I7A121 CrossRefPubMed

Lip GY, Nieuwlaat R, Pisters R, Lane DA, Crijns HJ (2010) Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the euro heart survey on atrial fibrillation. Chest 137:263–272. https://doi.org/10.1378/chest.09-1584 CrossRefPubMed

10.

Gage BF, Yan Y, Milligan PE, Waterman AD, Culverhouse R, Rich MW, Radford MJ (2006) Clinical classification schemes for predicting hemorrhage: results from the National Registry of Atrial Fibrillation (NRAF). Am Heart J 151:713–719. https://doi.org/10.1016/j.ahj.2005.04.017 CrossRefPubMed

11.

Pisters R, Lane DA, Nieuwlaat R, de Vos CB, Crijns HJ, Lip GY (2010) A novel user-friendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation: the Euro Heart Survey. Chest 138:1093–1100. https://doi.org/10.1378/chest.10-0134 CrossRefPubMed

12.

Rodés-Cabau J, Dauerman HL, Cohen MG, Mehran R, Small EM, Smyth SS, Costa MA, Mega JL, O’Donoghue ML, Ohman EM, Becker RC (2013) Antithrombotic treatment in transcatheter aortic valve implantation: insights for cerebrovascular and bleeding events. J Am Coll Cardiol 62:2349–2359. https://doi.org/10.1016/j.jacc.2013.03.029 CrossRefPubMed

13.

Collet JP, Montalescot G (2013) Antithrombotic and antiplatelet therapy in TAVI patients: a fallow field? EuroIntervention 9(Suppl):S43–S47. https://doi.org/10.4244/EIJV9SSA9 CrossRef

14.

Lynch DR Jr, Dantzler D, Robbins M, Zhao D (2013) Considerations in antithrombotic therapy among patients undergoing transcatheter aortic valve implantation. J Thromb Thrombolysis 35:476–482. https://doi.org/10.1007/s11239-013-0886-z CrossRefPubMed

15.

Stortecky S, Buellesfeld L, Wenaweser P, Heg D, Pilgrim T, Khattab AA, Gloekler S, Huber C, Nietlispach F, Meier B, Jüni P, Windecker S (2013) Atrial fibrillation and aortic stenosis: impact on clinical outcomes among patients undergoing transcatheter aortic valve implantation. Circ Cardiovasc Interv 6:77–84. https://doi.org/10.1161/CIRCINTERVENTIONS.112.000124 CrossRefPubMed

16.

Gargiulo G, Collet JP, Valgimigli M (2015) Antithrombotic therapy in TAVI patients: changing concepts. EuroIntervention 11(Suppl W):W92–W95. https://doi.org/10.4244/EIJV11SWA28 CrossRef

17.

Hamm CW, Arsalan M, Mack MJ (2016) The future of transcatheter aortic valve implantation. Eur Heart J 37:803–810. https://doi.org/10.1093/eurheartj/ehv574 CrossRefPubMed

18.

Makkar RR, Fontana G, Jilaihawi H, Chakravarty T, Kofoed KF, de Backer O, Asch FM, Ruiz CE, Olsen NT, Trento A, Friedman J, Berman D, Cheng W, Kashif M, Jelnin V, Kliger CA, Guo H, Pichard AD, Weissman NJ, Kapadia S, Manasse E, Bhatt DL, Leon MB, Søndergaard L (2015) Possible subclinical leaflet thrombosis in bioprosthetic aortic valves. N Engl J Med 373:2015–2024. https://doi.org/10.1056/NEJMoa1509233 CrossRefPubMed

19.

Ruile P, Jander N, Blanke P, Schoechlin S, Reinöhl J, Gick M, Rothe J, Langer M, Leipsic J, Buettner HJ, Neumann FJ, Pache G (2017) Course of early subclinical leaflet thrombosis after transcatheter aortic valve implantation. Clin Res Cardiol 106:85–95. https://doi.org/10.1007/s00392-016-1052-3 CrossRefPubMed

20.

Généreux P, Cohen DJ, Mack M, Rodes-Cabau J, Yadav M, Xu K, Parvataneni R, Hahn R, Kodali SK, Webb JG, Leon MB (2014) Incidence, predictors, and prognostic impact of late bleeding complications after transcatheter aortic valve replacement. J Am Coll Cardiol 64:2605–2615. https://doi.org/10.1016/j.jacc.2014.08.052 CrossRefPubMed

21.

Hohnloser SH, Basic E, Nabauer M (2017) Comparative risk of major bleeding with new oral anticoagulants (NOACs) and phenprocoumon in patients with atrial fibrillation: a post-marketing surveillance study. Clin Res Cardiol 106:618–628. https://doi.org/10.1007/s00392-017-1098-x CrossRefPubMed

Titel: NOAC monotherapy in patients with concomitant indications for oral anticoagulation undergoing transcatheter aortic valve implantation
verfasst von: Nicolas A. Geis
Christina Kiriakou
Emmanuel Chorianopoulos
Lorenz Uhlmann
Hugo A. Katus
Raffi Bekeredjian
Publikationsdatum: 11.04.2018
Verlag: Springer Berlin Heidelberg
Erschienen in: Clinical Research in Cardiology / Ausgabe 9/2018
Print ISSN: 1861-0684
Elektronische ISSN: 1861-0692
DOI: https://doi.org/10.1007/s00392-018-1247-x

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NOAC monotherapy in patients with concomitant indications for oral anticoagulation undergoing transcatheter aortic valve implantation

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Conclusions

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Abstract

Aims

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Conclusions

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