Aspirin Versus Warfarin after Transcatheter Aortic Valve Replacement in Low-Risk Patients: 2-Year Follow-Up

• Published in: The American journal of cardiology Vol. 206; pp. 108 - 115
• Main Authors: Merdler, Ilan, Rogers, Toby, Case, Brian C., Bhogal, Sukhdeep, Reddy, Pavan K., Ben-Dor, Itsik, Zhang, Cheng, Satler, Lowell F., Weissman, Gaby, Waksman, Ron
• Format: Journal Article
• Language: English
• Published: New York Elsevier Inc 01-11-2023; Elsevier Limited
• Subjects: Anticoagulants; anticoagulation; antiplatelet; Antiplatelet therapy; Aorta; Aortic valve; Aspirin; Cerebral infarction; Clinical outcomes; Echocardiography; Edema; Ejection fraction; Heart attacks; Heart valves; Hemodynamics; low risk; Mortality; Myocardial infarction; Patients; Pressure gradients; Prevention; Risk; Risk groups; TAVI; TAVR; Thromboembolism; Thrombosis; Warfarin; United States > US; low risk; antiplatelet; TAVR; anticoagulation; TAVI
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2023.08.076

Subclinical leaflet thrombosis occurs with transcatheter heart valves (THVs) and could be associated with structural valve deterioration. The current guidelines recommend the use of antiplatelet agents after transcatheter aortic valve replacement (TAVR) but not the routine use of oral anticoagulation. Our study examines the effects of short-term warfarin therapy on THV hemodynamics at 24 months after TAVR in low-risk patients. Low-risk patients who underwent TAVR were randomly allocated 1:1 to receive low-dose aspirin (n = 50) or low-dose aspirin plus warfarin (n = 44). After 30 days of treatment, ongoing medication regimens, including anticoagulation, were at the physicians’ discretion. Follow-up after a period of 24 months was available for clinical and echocardiographic outcomes. At the 24-month mark, follow-up echocardiography of the randomly allocated patients revealed just 1 additional case of new structural valve deterioration in the aspirin group (compared with the occurrence within 30 days), based on the Valve Academic Research Consortium 3 definitions. There were also no differences in mean pressure gradients (11.5 ± 0.5 mm Hg vs 11.05 ± 4.0 mm Hg, p = 0.6) or peak velocity (2.2 ± 0.5 m/s vs 2.1 ± 0.4 m/s, p = 0.7) between the groups. A composite end point (mortality, stroke, and myocardial infarction) did not show any difference between the groups at long-term follow-up (p = 0.07). In conclusion, in low-risk patients who underwent TAVR, short-term anticoagulation with warfarin did not impact clinical outcomes or THV hemodynamics by echocardiography at 24 months.