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Title: Impact of anticoagulation therapy on valve haemodynamic deterioration following transcatheter aortic valve replacement.
Authors: Del Trigo, María
Muñoz-García, Antonio J
Latib, Azeem
Auffret, Vincent
Wijeysundera, Harindra C
Nombela-Franco, Luis
Gutierrez, Enrique
Cheema, Asim N
Serra, Vicenç
Amat-Santos, Ignacio J
Kefer, Joelle
Benitez, Luis Miguel
Leclercq, Florence
Mangieri, Antonio
Le Breton, Hervé
Jiménez-Quevedo, Pilar
Garcia Del Blanco, Bruno
Dager, Antonio
Abdul-Jawad Altisent, Omar
Puri, Rishi
Pibarot, Philippe
Rodés-Cabau, Josep
Keywords: aortic stenosis;transcatheter valve interventions
metadata.dc.subject.mesh: Aged
Aged, 80 and over
Aortic Valve
Aortic Valve Stenosis
Fibrinolytic Agents
Follow-Up Studies
Heart Valve Prosthesis
Kaplan-Meier Estimate
Postoperative Complications
Transcatheter Aortic Valve Replacement
Treatment Outcome
Issue Date: 13-Feb-2018
Abstract: To evaluate the changes in transvalvular gradients and the incidence of valve haemodynamic deterioration (VHD) following transcatheter aortic valve replacement (TAVR), according to use of anticoagulation therapy. This multicentre study included 2466 patients (46% men; mean age 81±7 years) who underwent TAVR with echocardiography performed at 12-month follow-up. Anticoagulation therapy was used in 707 patients (28.7%) following TAVR (AC group). A total of 663 patients received vitamin K antagonists, and 44 patients received direct oral anticoagulants. A propensity score matching analysis was performed to adjust for intergroup (AC vs non-AC post-TAVR) differences. A total of 622 patients per group were included in the propensity-matched analysis. VHD was defined as a ≥10 mm Hg increase in the mean transprosthetic gradient at follow-up (vs hospital discharge). The mean clinical follow-up was 29±18 months. The mean transvalvular gradient significantly increased at follow-up in the non-AC group within the global cohort (P=0.003), whereas it remained stable over time in the AC group (P=0.323). The incidence of VHD was significantly lower in the AC group (0.6%) compared with the non-AC group (3.7%, P The lack of anticoagulation therapy post-TAVR was associated with significant increments in transvalvular gradients and a greater risk of VHD. VHD was subclinical in most cases and did not associate with major adverse clinical events. Future randomised trials are needed to determine if systematic anticoagulation therapy post-TAVR would reduce the incidence of VHD.
metadata.dc.identifier.doi: 10.1136/heartjnl-2017-312514
Appears in Collections:Producción 2020

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