Should We Continue or Interrupt Oral Anticoagulation in Patients Undergoing TAVR?

Continued anticoagulation led to higher rates of bleeding than an interruption strategy, with no benefit for stroke or other thrombotic complications.

In most Western countries, approximately one third of patients undergoing transcatheter aortic-valve replacement (TAVR) are taking oral anticoagulants (OACs) to treat atrial fibrillation or other conditions (e.g., mechanical heart valve, history of pulmonary embolism). However, little guidance exists on whether to continue or interrupt these agents around the time of TAVR. To inform these decisions, the PAUSE-TAVI investigators randomized 869 patients receiving long-term OACs and awaiting TAVR via femoral or subclavian access to either OAC continuation through the time of the procedure or OAC interruption beforehand.

Analyses included 858 patients (mean age, 81; 34% women; 82% receiving a direct OAC). In the interruption group, vitamin K ant…

Reviewing Author

David J. Cohen, MD, MSc

Disclosures

Consultant/Advisory BoardMedtronic; Edwards Lifesciences; Abbott Vascular; Boston Scientific; St. Francis Hospital

Speaker’s BureauBoston Scientific; ZOLL Medical

Grant/Research SupportEdwards Lifesciences; Abbott Vascular; Boston Scientific; Corvia Medical; National Heart, Lung, and Blood Institute; Phillips, Inc.; St. Paul’s Hospital; V-Wave, Inc; ZOLL Medical; CathWorks, ANCORA

Editorial BoardsJACC; American Heart Journal; EuroIntervention; JSCAI; Structural Heart Journal

Leadership Positions in Professional SocietiesSociety of Thoracic Surgeons/American College of Cardiology TVT Registry (Co-Chair, Risk Model Development Committee); Cardiovascular Research Foundation (Co-Director, TCT Annual Meeting; Co-Director, New York Valves Annual Meeting)