Pre-operative Continued Oral Anticoagulation Impact on Early Outcomes After Transcatheter Aortic Valve Implantation.
Considering that there is a lack of evidence and guideline-based recommendations on the best preoperative anticoagulation management (OAC) for transcatheter aortic valve implantation (TAVI), this cohort study aimed to evaluate bleeding, access site complications, and early safety in patients undergoing TAVI on continued OAC therapy vs. no-OAC therapy. Three-hundred forty-four patients submitted to a TAVI procedure (66.3% no-OAC vs. 33.7% OAC) were consecutively enrolled. Primary endpoint was defined as in-hospital VARC-2 life-threatening or disabling bleeding. Secondary endpoints were in-hospital VARC-2 major vascular complications, and VARC-2 early safety at 30 days. Propensity score matching analysis was performed to reduce potential distribution bias, resulting in 2 well-balanced groups (92 patients in each arm). In the overall cohort, mean age, median EuroScore II, and STS-score were 78.7±7.6, 2.9 (1.7-5.9), and 2.3 (1.6-3.6), respectively. Despite being older (78±8 vs. 80±6, p=0.004) and having higher STS score (2.1 vs. 2.6, p=0.001), patients on OAC had similar incidence of in-hospital VARC-2 life-threatening or disabling bleeding (1.3% vs. 0.9%, p=0.711), major vascular complications (4.8% vs. 5.2%, p=0.888), and VARC-2 early safety at 30 days (10.1% vs. 12.1%, p=0.575). No significant differences in the main outcomes were observed when propensity score matching was applied. In conclusion, the management of patients on OAC submitted to a TAVI procedure is challenging and requires balancing the risk of bleeding with the risk of thromboembolic events. The present study suggests that continued OAC was not associated with increased in-hospital VARC-2 life-threatening or disabling bleeding, major vascular complications, and VARC-2 early safety at 30 days.
Authors: Ana Paula Tagliari, Daniel Perez-Camargo, Enrico Ferrari, Philipp K Haager, Lucas Jörg, Marco Gennari, Mi Chen, Mara Gavazzoni, Ahmed Aziz Khattab, Stefan Blöchlinger, Francesco Maisano, Maurizio Taramasso