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Article Dans Une Revue JACC: Cardiovascular Interventions Année : 2021

TAVR Patients Requiring Anticoagulation: Direct Oral Anticoagulant or Vitamin K Antagonist?

1 Service de cardiologie [Brest]
2 CHU Toulouse - Centre Hospitalier Universitaire de Toulouse
3 LTSI - Laboratoire Traitement du Signal et de l'Image
4 EnVI - Endothélium, valvulopathies et insuffisance cardiaque
5 CHU Rouen
6 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Ponchaillou]
7 CHU Nîmes - Centre Hospitalier Universitaire de Nîmes
8 UM - Université de Montpellier
9 PLF - Polyclinique Les Fleurs - ELSAN
10 ICAN - Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases
11 Institut de cardiologie [CHU Pitié-Salpêtrière]
12 CHU Pitié-Salpêtrière [AP-HP]
13 TIMONE - Hôpital de la Timone [CHU - APHM]
14 Clinique Pasteur [Toulouse]
15 Service de chirurgie thoracique cardiaque et vasculaire [Rennes] = Thoracic and Cardiovascular Surgery [Rennes]
16 Hôpital Saint-Joseph [Marseille]
17 SU - Sorbonne Université
18 CHU Henri Mondor [Créteil]
19 AP-HP - Hôpital Bichat - Claude Bernard [Paris]
20 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]
21 IGH - Institut de génétique humaine
22 CHRU Lille - Centre Hospitalier Régional Universitaire [CHU Lille]
23 Service d'Oto-Rhino-Laryngologie (O.R.L.) et de Chirurgie Cervico-Faciale [CHU Caen]
24 CTSGA - Nouvelle Clinique de Tours Saint Gatien-Alliance [Tours]
25 CarMeN - Cardiovasculaire, métabolisme, diabétologie et nutrition
26 CHU Bordeaux
27 PCVP / CARDIO - Marqueurs pronostiques et facteurs de régulations des pathologies cardiaques et vasculaires - UFC ( UR 3920)
28 CCML - Centre Chirurgical Marie Lannelongue
29 Service de Cardiologie [CHU Nantes]
30 MPIC - Max Planck Institute for Chemistry
31 CHU Angers - Centre Hospitalier Universitaire d'Angers
32 Hôpital privé de Parly 2 - Ramsay Santé [Le Chesnay-Rocquencourt]
33 CHU Clermont-Ferrand
34 CHU Strasbourg - Centre Hospitalier Universitaire [Strasbourg]
35 MLV - Médipôle Lyon-Villeurbanne
36 Hôpital privé de Bois-Bernard - Ramsay Santé [Bois-Bernard]
37 CIPL - Clinique de l'Infirmerie Protestante de Lyon
38 CCTM - Centre Cardio-Thoracique de Monaco
39 C2VN - Centre recherche en CardioVasculaire et Nutrition = Center for CardioVascular and Nutrition research
40 CHUGA - Centre Hospitalier Universitaire [CHU Grenoble]
41 Service de cardiologie [CHU Bichat]
42 CHU - BREST - Hôpital de la Cavale Blanche - CHRU Brest
Romain Didier
Philippe Commeau
Frédéric Collet
  • Fonction : Auteur
Louis Labrousse
  • Fonction : Auteur
Bernard Iung

Résumé

OBJECTIVES: Using French transcatheter aortic valve replacement (TAVR) registries linked with the nationwide administrative databases, the study compared the rates of long-term mortality, bleeding, and ischemic events after TAVR in patients requiring oral anticoagulation with direct oral anticoagulants (DOACs) or vitamin K antagonists (VKAs). BACKGROUND: The choice of optimal drug for anticoagulation after TAVR remains debated. METHODS: Data from the France-TAVI and FRANCE-2 registries were linked to the French national health single-payer claims database, from 2010 to 2017. Propensity score matching was used to reduce treatment-selection bias. Two primary endpoints were death from any cause (efficacy) and major bleeding (safety). RESULTS: A total of 24,581 patients who underwent TAVR were included and 8,962 (36.4%) were treated with OAC. Among anticoagulated patients, 2,180 (24.3%) were on DOACs. After propensity matching, at 3 years, mortality (hazard ratio [HR]: 1.37; 95% confidence interval [CI]: 1.12-1.67; P \textless 0.005) and major bleeding including hemorrhagic stroke (HR: 1.64; 95% CI: 1.17-2.29; P \textless 0.005) were lower in patients on DOACs compared with those on VKAs. The rates of ischemic stroke (HR: 1.32; 95% CI: 0.81-2.15; P = 0.27) and acute coronary syndrome (HR: 1.17; 95% CI: 0.68-1.99; P = 0.57) did not differ among groups. CONCLUSIONS: In these large multicenter French TAVR registries with an exhaustive clinical follow-up, the long-term mortality and major bleeding were lower with DOACs than VKAs at discharge. The present study supports preferential use of DOACs rather than VKAs in patients requiring oral anticoagulation therapy after TAVR.
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Dates et versions

inserm-03452171 , version 1 (26-11-2021)

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Romain Didier, Thibault Lhermusier, Vincent Auffret, Hélène Eltchaninoff, Herve Le Breton, et al.. TAVR Patients Requiring Anticoagulation: Direct Oral Anticoagulant or Vitamin K Antagonist?. JACC: Cardiovascular Interventions, 2021, 14 (15), pp.1704-1713. ⟨10.1016/j.jcin.2021.05.025⟩. ⟨inserm-03452171⟩
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