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- Title
Comparison of Warfarin to Dual Antiplatelet Therapy Following Transcatheter Aortic Valve Replacement.
- Authors
Nei, Scott D.; Wieruszewski, Patrick M.; Scott, Rachael; Greason, Kevin L.
- Abstract
Introduction: Dual antiplatelet therapy (DAPT) was the initial antithrombotic regimen of choice following transcatheter aortic valve replacement (TAVR). Subsequent identification of subclinical valve thrombosis in high-risk patients has questioned whether warfarin should be used as an alternative to DAPT for some patients. Objective: The aim of this study was to compare thromboembolic events, bleeding, and all-cause mortality between DAPT and warfarin following TAVR. Methods: This was a single-center, retrospective review of TAVR patients who received DAPT or warfarin following TAVR between 2008 and 2018. The primary endpoint was occurrence of thromboembolic events during the hospital stay and 1-year follow-up, while secondary endpoints included bleeding and all-cause mortality. Results: Of the included 764 patients, 193 received DAPT and 571 received warfarin. The median Society of Thoracic Surgeons (STS) Predicted Risk of Mortality (PROM) scores were 8.3% for the DAPT group and 6.5% for the warfarin group. The primary endpoint occurred 30 times (3.9%) during the study timeframe. No differences in thromboembolic events between the DAPT and warfarin groups were found (4.14% vs. 3.85%; p = 0.857), and there was no difference in bleeding (6.22% vs. 5.08%; p = 0.544) or risk of mortality (hazard ratio 0.59, 95% confidence interval 0.33–1.06; p = 0.076). Conclusions: In this study, warfarin had similar effectiveness and safety, compared with DAPT, for antithrombotic management post-TAVR. For patients whom the provider deemed anticoagulation is indicated, our data suggest warfarin is a well-tolerated option following TAVR in intermediate- and high-risk STS score patients.
- Subjects
WARFARIN; SURGICAL complication risk factors; THROMBOEMBOLISM risk factors; HEMORRHAGE risk factors; MORTALITY risk factors; PREVENTION of surgical complications; HEART valve prosthesis implantation; COMBINATION drug therapy; CONFIDENCE intervals; POSTOPERATIVE care; RETROSPECTIVE studies; TREATMENT effectiveness; RISK assessment; COMPARATIVE studies; PLATELET aggregation inhibitors; DESCRIPTIVE statistics
- Publication
American Journal of Cardiovascular Drugs, 2021, Vol 21, Issue 4, p453
- ISSN
1175-3277
- Publication type
Article
- DOI
10.1007/s40256-020-00443-9