Introduction

Dual antiplatelet therapy (DAPT) was the initial antithrombotic regimen of choice following transcatheter aortic valve replacement (TAVR). Subsequent identification of subclinical valve thrombosis in high-risk patients has questioned whether warfarin should be used as an alternative to DAPT for some patients.

Objective

The aim of this study was to compare thromboembolic events, bleeding, and all-cause mortality between DAPT and warfarin following TAVR.

Methods

This was a single-center, retrospective review of TAVR patients who received DAPT or warfarin following TAVR between 2008 and 2018. The primary endpoint was occurrence of thromboembolic events during the hospital stay and 1-year follow-up, while secondary endpoints included bleeding and all-cause mortality.

Results

Of the included 764 patients, 193 received DAPT and 571 received warfarin. The median Society of Thoracic Surgeons (STS) Predicted Risk of Mortality (PROM) scores were 8.3% for the DAPT group and 6.5% for the warfarin group. The primary endpoint occurred 30 times (3.9%) during the study timeframe. No differences in thromboembolic events between the DAPT and warfarin groups were found (4.14% vs. 3.85%; p = 0.857), and there was no difference in bleeding (6.22% vs. 5.08%; p = 0.544) or risk of mortality (hazard ratio 0.59, 95% confidence interval 0.33–1.06; p = 0.076).

Conclusions

In this study, warfarin had similar effectiveness and safety, compared with DAPT, for antithrombotic management post-TAVR. For patients whom the provider deemed anticoagulation is indicated, our data suggest warfarin is a well-tolerated option following TAVR in intermediate- and high-risk STS score patients.

中文翻译：

---

经导管主动脉瓣置换术后华法林与双重抗血小板治疗的比较

介绍

双联抗血小板治疗 (DAPT) 是经导管主动脉瓣置换术 (TAVR) 后首选的初始抗血栓治疗方案。随后在高危患者中发现亚临床瓣膜血栓形成，对某些患者是否应使用华法林作为 DAPT 的替代品提出了质疑。

客观的

本研究的目的是比较 TAVR 后 DAPT 和华法林之间的血栓栓塞事件、出血和全因死亡率。

方法

这是对 2008 年至 2018 年间接受 TAVR 后接受 DAPT 或华法林的 TAVR 患者的单中心回顾性研究。主要终点是住院期间和 1 年随访期间血栓栓塞事件的发生，而次要终点包括出血和全因死亡率。

结果

在纳入的 764 名患者中，193 名接受了 DAPT，571 名接受了华法林。DAPT 组和华法林组的胸外科医师协会 (STS) 预测死亡风险 (PROM) 评分的中位数分别为 8.3% 和 6.5%。在研究时间范围内，主要终点发生了 30 次 (3.9%)。未发现 DAPT 和华法林组之间血栓栓塞事件的差异（4.14% 对 3.85%；p  = 0.857），出血（6.22% 对 5.08%；p  = 0.544）或死亡风险没有差异（风险比 0.59，95% 置信区间 0.33–1.06；p  = 0.076）。

结论

在这项研究中，与 DAPT 相比，华法林在 TAVR 后抗血栓治疗方面具有相似的有效性和安全性。对于提供者认为需要抗凝治疗的患者，我们的数据表明华法林是中危和高危 STS 评分患者在 TAVR 后耐受性良好的选择。