Universität zu Köln

Hohmann, Christopher, Ludwig, Marion, Walker, Jochen, Wienemann, Hendrik, Baldus, Stephan and Pfister, Roman (2021). Real-World Anticoagulatory Treatment After Transcatheter Aortic Valve Replacement: A Retrospective, Observational Study on 4,800 Patients. Front. Cardiovasc. Med., 8. LAUSANNE: FRONTIERS MEDIA SA. ISSN 2297-055X

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Abstract

Background: Transcatheter aortic valve replacement (TAVR) has developed to the therapy of choice for patients with symptomatic severe aortic stenosis who are unsuitable for surgical aortic valve replacement and elderly patients with intermediate or high operative risk. However, the optimal anticoagulant therapy post-TAVR still remains a matter of debate.Aims: This study sought to investigate current anticoagulant treatment patterns and clinical outcome in patients undergoing TAVR.Methods: In a retrospective study based on anonymized health claims data of approximately seven million Germans with statutory health insurance (InGef database), anticoagulant treatment regimens were assessed using any drug prescription post discharge within the first 90 days after TAVR procedure. Clinical events between 30 days and 6 months were examined by treatment regime.Results: The study population comprised 4,812 patients with TAVR between 2014 and 2018: 29.4% received antiplatelet monotherapy, 17.8% dual antiplatelet therapy, 17.4% oral anticoagulation (OAC) plus antiplatelet therapy, 12.9% OAC monotherapy, 2.2% triple therapy and 19.2% did not receive any anticoagulatory drugs. Sixty-four percentage of patients with OAC received direct oral anticoagulants (DOAC). Hence, 68% of all patients were treated non-adherent to current guidelines. Forty percentage of patients with OAC prior to TAVR did not have any OAC after TAVR. The adjusted risk of all-cause mortality was significantly increased in patients with OAC (HR 1.40, 95% CI 1.03-1.90, p = 0.03) and no anticoagulatory treatment (HR 3.95, 95% CI 2.95-5.27, p < 0.0001) when compared to antiplatelet monotherapy.Conclusions: This large real-world data analysis demonstrates substantial deviations from guideline recommendations and treatment after TAVR. Considering relevant differences in clinical outcome across treatment groups, major effort is warranted to examine underlying causes and improve guideline adherence.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Hohmann, Christopher UNSPECIFIED UNSPECIFIED UNSPECIFIED Ludwig, Marion UNSPECIFIED UNSPECIFIED UNSPECIFIED Walker, Jochen UNSPECIFIED UNSPECIFIED UNSPECIFIED Wienemann, Hendrik UNSPECIFIED UNSPECIFIED UNSPECIFIED Baldus, Stephan UNSPECIFIED UNSPECIFIED UNSPECIFIED Pfister, Roman UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-569515
DOI:	10.3389/fcvm.2021.780762
Journal or Publication Title:	Front. Cardiovasc. Med.
Volume:	8
Date:	2021
Publisher:	FRONTIERS MEDIA SA
Place of Publication:	LAUSANNE
ISSN:	2297-055X
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language DIRECT ORAL ANTICOAGULANTS; ATRIAL-FIBRILLATION; ANTIPLATELET THERAPY; PERCUTANEOUS CORONARY; ESC/EACTS GUIDELINES; EUROPEAN ASSOCIATION; CONSENSUS DOCUMENT; OUTCOMES; RISK; TAVI Multiple languages Cardiac & Cardiovascular Systems Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/56951