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Cardiovascular Disease

Anti-coagulation: impact on long-term mortality and early valve dysfunction

By: News Feed | Last updated: 19th September 2018 | In: Cardiovascular

Article Keywords

AF, anticoagulation, aspirin, atrial fibrillation, chronic kidney disease, CKD, clopidogrel, DAPT, OAC, valve dysfunction, valve replacement

Anticoagulation, which is often provided for atrial fibrillation (AF), decreases the risk of bioprosthetic valve dysfunction (BVD) after transcatheter aortic valve replacement (TAVR), according to the results of the FRANCE-TAVI registry study (NCT01777828). Male gender, chronic kidney disease (CKD), and atrial fibrillation (AF) have the highest impact on the 3-year mortality due to BVD after TAVR.

“The optimal anti-thrombotic treatment after TAVR remains a matter of debate. Dual antiplatelet therapy (DAPT) is recommended but single antiplatelet therapy or oral anticoagulation (OAC) are frequently used according to the patient profile. Whether this may impact clinical outcome is unknown.”

The prospective, multicentre FRANCE-TAVI registry study included 12,804 patients with mean age of 82.8 years old (SE: ±0.07 years) and logistic Euroscore 17.8% (SE: ±0.1%),  to identify independent factors of long-term all-cause mortality and early BVD. The protocol defined BVD as an increased prosthetic gradient ≥10 mmHg or a new gradient ≥20 mmHg.

At a mean duration of follow-up of 495 days (SE: ±3.5 days), 11,469 participants were alive when discharged and received documented antithrombotic treatment. Thirty-three per cent (3836/11,469) of the participants had a history of AF, and a similar proportion of patients was on oral anticoagulation upon discharge. Twenty-two per cent (2,555/11,469) of patients received at least two echocardiographic evaluations and were thus eligible for the BVD assessment.

The registry showed that anticoagulation at discharge (adj. OR 0.54; CI, 0.35-0.82; p=0.005) and a non-femoral approach (adj. OR 0.53; CI, 0.28-1.02; p=0.049) were independent correlates of lower rates of BVD. Aspirin nor clopidogrel independently associated with mortality.

Male gender (adj. HR 1.63; CI, 1.44-1.84; p<0.001), a history of AF (adj. HR 1.41; CI, 1.23-1.62; p<0.001), and CKD (adj. HR 1.37; CI, 1.23-1.53; p<0.001) had the strongest independent correlation with mortality. CKD (adj. OR 1.46; CI, 1.03-2.08; p=0.034) and prosthesis size ≤23mm (adj. OR 3.43; CI, 2.41-4.89; p<0.001) correlated to higher risk of BVD.

Reference

Overtchouk P, et al. J Am Coll Cardiol. 2018; doi: 10.1016/j.jacc.2018.08.1045.


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Disclaimer

This article is not medical advice. Patients should seek personal assessment by a licenced specialist. Physicians are recommended to read the full publication(s) as cited in the article before making medical decisions. This article does not supersede nor replace the published article(s).

© Copyright 2018 MediPaper Medical Communications Ltd. – Anti-coagulation: impact on long-term mortality and early valve dysfunction

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