Abstract 18678: Transcutaneous Aortic Valve Replacement -Is Anticoagulation Protective?
INTRODUCTION: Stroke continues to be the most dreaded and quality of life limiting complication of transcutaneous aortic valve replacement [TAVR]. We sought to describe the effects of Anticoagulation[AC] on post TAVR rates of stroke/transient ischemic attack[TIA] and death.
METHODS: 196 patients [116 self expanding and 80 balloon expandable] underwent TAVR from December 2010 to August 2013 at our institution. 1 month follow up was completed on all patients and 1 year follow up was available on 105 patients[TAVR prior to September 2012]. Of these, 59 patients were discharged on AC [55 on Coumadin, 4 on Dabigatran] and 137 patients without AC [NO-AC]
RESULTS: Atrial fibrillation/flutter[AF] incidence was higher with patients on AC vs NO-AC [ 73% vs 26% ,p <0.001] . There was no difference in diabetes, hypertension, hyperlipidemia, chronic kidney disease, prior MI or stroke, history of thromboembolism, prior gastrointestinal bleed , anemia or cirrhosis. Strokes/TIA after discharge on AC was seen in only 1 patient [subtherapeutic INR of 1.5] and 1 patient had an intracranial bleed on dabigatran vs 5 NO-AC patients [1.7% vs 3.7%, p=0.670].Mortality at I year [13.5 % AC vs 20.4% NO-AC p= 0.3167] - Figure 1. Statistical significance in primary outcomes was not met due to small number of patients
CONCLUSION: AC patients showed a trend towards improved survival and stroke rates. This difference can be hypothesized by the reduction in thromboemboli formation at the level of the valve struts. Further studies randomizing TAVR patients to AC and NOAC is needed to see if this observed difference translates to reduction in mortality and strokes.
Author Disclosures: A. Rajamanickam: None. K. Mucci: None. S. Basnet: None. R. Rao: None. J. Yee: None. U. Baber: None. G. Dangas: None. A. Kini: None. D. Adams: None. S. Sharma: None.
- © 2014 by American Heart Association, Inc.