Abstract 6935: DOACs Use in Very Elderly AF Patients After TAVR Confers Significant Risk of Thromboembolic Events Artículo de revista uri icon

Abstracto

  • Introduction: To assess the efficacy and safety of direct oral anticoagulants (DOACs) versus vitamin K antagonists (VKA) in very elderly patients with atrial fibrillation (AF) undergoing transcatheter aortic valve replacement (TAVR). Two efficacy outcomes were used: all-cause mortality and thromboembolic events (defined as stroke and/or transient ischemic attack and/or systemic embolism and/or valve thromboses) and one safety outcome: life-threatening or major bleeding events. There is a discrepancy between the results of previous studies on the appropriate anticoagulation regimen in patients with AF with CHA 2 DS 2 Vasc score≥2 undergoing TAVR Methods: A systematic review of Medline, Cochrane, and Embase was done to find all studies in which the previously described outcomes in AF patients undergoing TAVR were compared according to their use of DOACs vs. VKA. Results: Six studies with a total 3,631 participants, mean follow-up 19±9.4 months (male: 30.3%, mean ages were 82.8±1.1 years and 82.2±1.5 years for the DOAC and the VKA groups, respectively) were included in our analysis. No significant differences were found between the DOAC and VKA group in all-cause mortality (Risk Ratio [RR] 1.06, 95% Confidence Interval [CI] 0.84-1.35) or life-threatening or major bleeding events (RR 1.02, 95% CI 0.83-1.25). A significant increase in risk of thromboembolic events was found in the DOAC group (RR 1.23, 95% CI 1.05-1.44). Conclusions: VKA should be preferred over DOACs in very elderly patients with AF who undergo TAVR, given the significantly increased risk in thromboembolic events seen with DOACs and the lack of significant difference in all-cause mortality and bleeding. RCTs are needed to confirm or refute our findings.

autores

  • Cerrud-Rodriguez, Roberto C
  • Wiley, Karlo A
  • Castillero, Isabella
  • Goodwin, Ashley
  • Saralidze, Tinatin
  • Villablanca, Pedro A
  • Gonzalez, Maday
  • Terre, Juan
  • Wiley, Jose
  • Di Biase, Luigi

fecha de publicación

  • 2021

Volumen

  • 144

Cuestión

  • Suppl_1