Direct Oral Anticoagulants Versus Vitamin K Antagonists in Patients With Atrial Fibrillation After TAVR
Direct Oral Anticoagulants Versus Vitamin K Antagonists in Patients With Atrial Fibrillation After TAVR
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DOI：
10.1016/j.jcin.2020.09.013
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发表时间：
2020-11-23
影响因子：
11.3
通讯作者：
Hayashida, Kentaro
中科院分区：
文献类型：
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作者：
Kawashima, Hideyuki;Watanabe, Yusuke;Hayashida, Kentaro
本研究的目的是比较直接口服抗凝剂（DOAC）和维生素K拮抗剂（VKA）在经导管主动脉瓣置换术（TAVR）后房颤（AF）患者中的长期全因死亡率。背景TAVR后AF患者的最佳抗凝剂尚未阐明。（优化经导管瓣膜介入治疗）是一项前瞻性、多中心、观察性队列登记研究，包括2013年10月至2017年5月期间接受TAVR的2，588例患者。其中，确定了403例（15.6%）接受抗凝治疗的AF患者，其中227例（56.3%）处方DOAC，176例（43.7%）处方VKA。TAVR后成功出院的患者根据抗凝药物处方分为DOAC和VKA组，分析从出院开始。平均年龄为84.4 ± 4.7岁，平均CHA 2DS 2-VASc评分为5.1 ± 1.1。中位随访时间为568天。多变量考克斯回归模型和基于倾向评分的治疗加权逆概率证明，DOAC组的全因死亡率显著低于VKA组（10.3% vs. 23.3%; Cox校正风险比：0.391; 95%置信区间：0.204 - 0.749; p = 0.005; 10.2% vs. 20.6%;治疗权重校正风险比的逆概率：0.531; 95%置信区间：0.294至0.961; p = 0.036）。结论：与VKA相比，DOAC可能与TAVR后成功出院的伴发AF患者的长期小原因死亡率较低相关。这一发现值得在正在进行的前瞻性随机试验中进行研究。(C)2020年由美国心脏病学会基金会。
OBJECTIVES The aimof this study was to compare long-term all-causemortality between direct oral anticoagulants (DOACs) and vitamin K antagonists (VKAs) in patients with atrial fibrillation (AF) after transcatheter aortic valve replacement (TAVR).BACKGROUND The optimal anticoagulant agent for patients with AF after TAVR has not been clarified.METHODS OCEAN (Optimized Transcatheter Valvular Intervention) is a prospective, multicenter, observational cohort registry comprising 2,588 patients who underwent TAVR between October 2013 and May 2017. Of these, 403 patients (15.6%) with AF on anticoagulant therapy were identified, of whom 227 (56.3%) were prescribed DOACs and 176 (43.7%) were prescribed VKAs. Patients who successfully discharged after TAVR were stratified into DOAC and VKA groups on the basis of the prescription of anticoagulant agents, and the analyses started from discharge.RESULTS In total, 33.3% of patients were men. The mean age was 84.4 +/- 4.7 years, and the average CHA2DS2-VASc score was 5.1 +/- 1.1. The median follow-up duration was 568 days. A multivariate Cox regression model and inverse probability of treatment weighting based on the propensity score demonstrated that the DOAC group was significantly associated with a lower incidence of all-cause mortality compared with the VKA group (10.3% vs. 23.3%; Cox-adjusted hazard ratio: 0.391; 95% confidence interval: 0.204 to 0.749; p = 0.005; and 10.2% vs. 20.6%; inverse probability of treatment weighting-adjusted hazard ratio: 0.531; 95% confidence interval: 0.294 to 0.961; p = 0.036, respectively).CONCLUSIONS Compared with VKAs, DOACs might be associatedwith lower long-termall-causemortality in patientswith concomitant AF who are successfully discharged after TAVR. This finding warrants investigation in ongoing prospective randomized trials. (C) 2020 by the American College of Cardiology Foundation.