Rates of anticoagulation following transcatheter aortic valve replacement in patients with atrial fibrillation

Document Type

Conference Proceeding

Publication Date


Publication Title

Am Coll Cardiol


Background: Late strokes have been observed to occur inhigh rates post-transcatheter aortic valve replacement(TAVR). Atrial fibrillation (AF) is a common co-morbidity inTAVR patients, but anticoagulation is problematic due to age or frailty in this population. Our aim was to assess the quality of anticoagulation in TAVR patients with atrialfibrillation. Methods: In a single center retrospective study, we analyzed 500 patients who underwent TAVR. Patient characteristics and discharge medications were evaluated in the TAVR cohort with AF. Results: A signifcant portion ofpatients who underwent TAVR had atrial fibrillation (36.8%), with a mean CHADS2VASC of 5.8 + 1.2 and HAS-BLED of 3.4 + 0.1. Patient demographics (Table 1) were well matched aside from a higher rate of prior CABG in the AF cohort. Discharge anticoagulant medication regimen post-TAVR (Table 2) noted higher rates of warfarin prescriptions in AF patients, however only 50.2% of TAVR patients with AF were discharged on oral anticoagulation. The rates ofanticoagulation were not related to bleeding risk according to HAS-BLED scores (p=NS). Conclusion: Atrial fibrillation is a common problem in patients undergoing TAVR. In our population, approximately half of patients with AF were not discharged on anticoagulation post-TAVR and rates ofanticoagulation were not related to risk of bleeding. Barriers to prescribing oral anticoagulationthromboprophylaxis for atrial fibrillation in TAVR patientsshould be further investigated.





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