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Patients with atrial fibrillation (AF) undergoing transcatheter aortic valve replacement (TAVR) traditionally receive vitamin K antagonists (VKAs) because of the long history of warfarin use in patients with valve replacements and the inferiority of direct-acting oral anticoagulants (DOACs) compared with warfarin in those with mechanical valves. In the industry-funded, multicenter, open-label ENVISAGE-TAVI AF trial (NCT02943785), researchers compared the safety and efficacy of the DOAC edoxaban and a VKA in this setting.
Among 1426 patients randomized to edoxaban or a VKA for prevalent (99%) or incident AF after successful TAVR, during a median follow-up of approximately 1.5 years, the groups had similar rates of the composite primary effica…