Direct Oral Anticoagulants Versus Vitamin K Antagonists in Patients With Atrial Fibrillation After TAVR

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.