Oral anticoagulants shown to be safe and effective after aortic valve surgery

Patients undergoing transcatheter aortic valve replacement (TAVR) have similar postoperative ischaemic and bleeding outcomes regardless of whether they take oral anticoagulants for atrial fibrillation or standard antiplatelet therapy, cardiologists at a Victorian centre have shown.

In a prospective study conducted among patients having TAVR at the Monash Cardiovascular Research Centre, Melbourne, clinicians compared outcomes in 48 patients with AF receiving standard anticoagulant therapy to the 105 patients without AF who received the recommended antiplatelet therapy of aspirin and clopidogrel.

In the AF therapy group, about one third of patients were prescribed direct acting oral anticoagulants (DOACs), and almost all received anticoagulation in addition to single antiplatelet medication

For the primary endpoint of 6-month incidence of death, myocardial infarction, stroke/TIA or major life-threatening bleeding there was no significant difference in rates between the two groups (20.8% for standard AF therapy vs 17.7% for antiplatelet therapy).

There was also no significant difference in bleeding (12.5% vs 9.4%) or stroke/TIA (2.1% vs 8.3%) between anticoagulant therapy and antiplatelet therapy groups.

Study lead author Dr Samuel Hui and colleagues said the findings showed no excess risk of bleeding or stroke with oral anticoagulation, and this added to other literature supporting its use post TAVR.

“Given our low rate of observed ischaemic and bleeding events, the use of oral anticoagulation in AF patients post-TAVR appears to be safe and effective,” they wrote.

The findings are published in Heart Lung and Circulation.

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