# Summary

Type: Article
Publishing/Release Date: 2024/01/16
Publisher: ACC
Link: https://www.acc.org/Latest-in-Cardiology/Journal-Scans/2024/01/14/20/08/comparison-of-direct

与 VKA 相比，TMVR 后使用 DOAC 似乎可以降低出血并发症的风险并缩短患者的住院时间，而不会显着增加血栓事件的风险。

人群：2011 年至 2023 年间在其中心使用 SAPIEN 接受房间隔 TMVR 治疗的患者 156 例。

主要结局是出血的发生。

次要结局是血栓并发症（瓣膜血栓或中风）、死亡、主要血管并发症和住院时间。

患者一直服用 VKA 直至 2019 年 10 月，之后才开具 DOAC。

Quick Takes

In patients undergoing transcatheter mitral valve replacement (TMVR), the use of DOACs was associated with a lower incidence of bleeding complications than treatment with VKAs, with no significant differences in the risk of thrombotic events.
Furthermore, the use of DOACs was associated with a shorter length of hospital stay compared with VKAs.
Large randomized trials are needed to confirm these findings and guide selection of the optimum antithrombotic treatment strategy for patients undergoing TMVR.

# Study Questions:

What are the bleeding and thrombotic events associated with direct oral anticoagulants (DOACs) or vitamin K antagonists (VKAs) in a prospective cohort of patients who underwent transcatheter mitral valve replacement (TMVR)?

# Methods:

The investigators enrolled consecutive patients who underwent transseptal TMVR using a SAPIEN family prosthesis at their center between 2011 and 2023. The primary outcome was the occurrence of bleeding. The secondary outcomes were thrombotic complications (valve thrombosis or stroke), death, major vascular complications, and the length of stay. VKAs were administered to patients until October 2019, after which DOACs were prescribed. The median follow-up was 4.7 months (Q1-Q3: 2.6-6.7 months). Censored variables were evaluated using Kaplan-Meier estimates, and survival curves were compared using log-rank tests. Univariate and multivariable Cox regression models were utilized to assess the association between covariates and censored outcomes.

# Results:

A total of 156 patients were included. The mean age was 65 ± 18.5 years, and 103 patients (66%) were women. The median EuroSCORE II was 7.48% (Q1-Q3: 3.80%-12.97%). Of the participants, 20.5% received DOACs and 79.5% were treated with VKAs. The primary outcome was observed in 50 (40%) patients in the VKA group and 3 (9%) patients in the DOAC group (adjusted hazard ratio, 0.21; 95% confidence interval, 0.06-0.74; p = 0.02). Treatment with DOAC was associated with a shorter length of hospital stay. No significant differences were found in terms of thrombotic events, major vascular complications, stroke, or death.

# Conclusions:

The authors report that the use of DOACs after TMVR, compared with VKAs, appears to reduce the risk of bleeding complications and decrease the length of hospital stay for patients, without a significant increase in the risk of thrombotic events.

# Perspective:

This single-center study reports that in patients undergoing TMVR, the use of DOACs was associated with a lower incidence of bleeding complications than treatment with VKAs, particularly early bleeding events. with no significant differences in the risk of thrombotic events, including valve thrombosis, between DOACs and VKAs. Furthermore, the use of DOACs was associated with a shorter length of hospital stay compared with VKAs. Given the single-center observational nature of the study, these findings should be considered as hypothesis generating and large randomized trials are needed to confirm these findings and guide selection of the optimum antithrombotic treatment strategy for patients undergoing TMVR.