Rates of anticoagulation following transcatheter aortic valve replacement in patients with atrial fibrillation
Gorgis S, Abdelrahim E, Wang DD, Wyman JF, Paone G, Greenbaum A, Kendall B, O'Neill WW, Eng M. Rates of anticoagulation following transcatheter aortic valve replacement in patients with atrial fibrillation. J Am Coll Cardiol. 2018;71(11)
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.