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Comparison of warfarin versus DOACs in patients with concomitant indication for oral anticoagulation undergoing TAVI; results from the ATLAS registry

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Abstract

The optimal antithrombotic therapy for patients undergoing TAVI with concomitant indication for oral anticoagulation remains unclear. In this high-risk population group, there is a paucity of data with regards to the use of DOACs. In the present study we compared long-term clinical outcomes of TAVI patients requiring anticoagulation, treated with warfarin versus DOACs. Consecutive patients, who underwent TAVI with indication for oral anticoagulation from the multicenter ATLAS registry were studied and divided in two groups depending on the chosen anticoagulation regimen, warfarin vs. DOACs. 30-day survival, as well as estimated 1 and 2-year all-cause mortality were compared between groups. The secondary endpoint included in-hospital major or life-threatening bleeding. The study group included 217 patients (102 treated with warfarin; 115 treated with DOACs). Kaplan–Meier estimated survival was found to be statistically similar in the warfarin and DOAC groups (90.6% vs. 93.7% for 1-year and 84.5% vs. 88.5%, for 2-year survival, respectively, Plog-rank = 0.984). Adjusted hazard ratio for all cause mortality was similar between the two groups (HRwarfarin vs. DOAC = 1.15; 95% CI 0.33 to 4.04, p = 0.829). Propensity matching revealed similar results. At 30-days, all-cause mortality was found to be comparable between the two groups. With regards to BARC defined bleeding complications, major and life-threatening complications did not differ between the two anticoagulation groups (6% vs. 8% for warfarin and DOACs respectively, p = 0.857). DOACs seem to demonstrate a similar safety and efficacy profile compared to warfarin in TAVI patients with a concomitant indication for oral anticoagulation.

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Authors and Affiliations

  1. Department of Cardiology, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, Hill End Road, Harefield, Middlesex, London, UB9 6JH, UK

    Konstantinos Kalogeras, Samuel Watson, Tito Kabir, Miles Dalby & Vasileios Panoulas

  2. 1st Department of Cardiology, Hippokration Hospital, Medical School, National & Kapodistrian University of Athens, Athens, Greece

    Konstantinos Kalogeras & Manolis Vavuranakis

  3. Cardiovascular Sciences, National Heart and Lung Institute, Imperial College London, London, UK

    Richard J. Jabbour, Neil Ruparelia, Iqbal S. Malik, Ghada Mikhail, Miles Dalby & Vasileios Panoulas

  4. Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK

    Richard J. Jabbour, Neil Ruparelia, Iqbal S. Malik & Ghada Mikhail

  5. Department of Cardiology, New Tokyo Hospital, Matsudo, Japan

    Toru Naganuma & Sunao Nakamura

  6. 3rd Department of Cardiology, Sotiria Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece

    Manolis Vavuranakis

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  1. Konstantinos Kalogeras
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Kalogeras, K., Jabbour, R.J., Ruparelia, N. et al. Comparison of warfarin versus DOACs in patients with concomitant indication for oral anticoagulation undergoing TAVI; results from the ATLAS registry. J Thromb Thrombolysis 50, 82–89 (2020). https://doi.org/10.1007/s11239-019-01968-w

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