Direct Oral Anticoagulants Versus Vitamin K Antagonists After Mitral Valve Transcatheter Edge‐to‐Edge Repair in Patients With Atrial Fibrillation: A Single‐Center Observational Study
Background Mitral valve transcatheter edge‐to‐edge repair (M‐TEER) has emerged as a viable therapy option in patients with severe mitral regurgitation and high surgical risk. Although atrial fibrillation is common among patients undergoing M‐TEER, the optimal anticoagulatory treatment after the inte...
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| Language: | English |
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Wiley
2025-02-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
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| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.124.038834 |
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| author | Jan‐Hendrik Schipper Anne‐Sophie Sommer Richard Julius Nies Clemens Metze Max Maria Meertens Jonas Wörmann Sebastian Dittrich Jan‐Hendrik van den Bruck Arian Sultan Jakob Lüker Daniel Steven Christopher Hohmann Roman Pfister Stephan Baldus Ingo Eitel Christian Frerker Tobias Schmidt |
| author_facet | Jan‐Hendrik Schipper Anne‐Sophie Sommer Richard Julius Nies Clemens Metze Max Maria Meertens Jonas Wörmann Sebastian Dittrich Jan‐Hendrik van den Bruck Arian Sultan Jakob Lüker Daniel Steven Christopher Hohmann Roman Pfister Stephan Baldus Ingo Eitel Christian Frerker Tobias Schmidt |
| author_sort | Jan‐Hendrik Schipper |
| collection | DOAJ |
| description | Background Mitral valve transcatheter edge‐to‐edge repair (M‐TEER) has emerged as a viable therapy option in patients with severe mitral regurgitation and high surgical risk. Although atrial fibrillation is common among patients undergoing M‐TEER, the optimal anticoagulatory treatment after the intervention is unknown. Methods A single‐center retrospective observational analysis was conducted using data from the M‐TEER registry at the University Hospital Cologne collected from 2019 untill 2021 including patients undergoing M‐TEER between November 2012 and April 2019. Patients with atrial fibrillation receiving consistent anticoagulation following M‐TEER were categorized into a direct oral anticoagulant or a vitamin K antagonist (VKA) group. The primary end point was a composite of ischemic cerebrovascular and bleeding events. Additionally, overall survival was assessed. Results Among 613 patients undergoing M‐TEER, 206 met the inclusion criteria, with 61 receiving direct oral anticoagulants and 145 receiving VKAs. After a median follow‐up of 833 (interquartile range, 355–1271) days, the incidence of the composite primary end point did not differ between direct oral anticoagulant and VKA groups (hazard ratio [HR], 0.51 [95% CI, 0.23–1.12]; P=0.07). Similarly, rates of ischemic cerebrovascular events and bleeding events were similar between groups. However, the overall mortality rate was higher in the VKA group (HR, 2.56 [95% CI, 1.54–4.26]; P=0.002). In the multivariable analysis, oral anticoagulation with a VKA was an independent predictor for death (adjusted HR, 2.23 [95% CI, 1.08–5.06]; P=0.03). Conclusions Our findings suggest that direct oral anticoagulants may offer comparable efficacy and safety to VKAs in preventing thromboembolic events following M‐TEER in patients with atrial fibrillation. Further randomized trials are needed to confirm these results and establish optimal anticoagulation strategies in this patient population. |
| format | Article |
| id | doaj-art-5d34e62f39834e77a5688b93fd16b6a7 |
| institution | Kabale University |
| issn | 2047-9980 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj-art-5d34e62f39834e77a5688b93fd16b6a72025-02-04T11:00:01ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802025-02-0114310.1161/JAHA.124.038834Direct Oral Anticoagulants Versus Vitamin K Antagonists After Mitral Valve Transcatheter Edge‐to‐Edge Repair in Patients With Atrial Fibrillation: A Single‐Center Observational StudyJan‐Hendrik Schipper0Anne‐Sophie Sommer1Richard Julius Nies2Clemens Metze3Max Maria Meertens4Jonas Wörmann5Sebastian Dittrich6Jan‐Hendrik van den Bruck7Arian Sultan8Jakob Lüker9Daniel Steven10Christopher Hohmann11Roman Pfister12Stephan Baldus13Ingo Eitel14Christian Frerker15Tobias Schmidt16Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine University of Cologne GermanyFaculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine University of Cologne GermanyFaculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine University of Cologne GermanyFaculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine University of Cologne GermanyFaculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine University of Cologne GermanyFaculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine University of Cologne GermanyFaculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine University of Cologne GermanyFaculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine University of Cologne GermanyAsklepios Klinik St. Georg Hamburg GermanyFaculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine University of Cologne GermanyFaculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine University of Cologne GermanyFaculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine University of Cologne GermanyFaculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine University of Cologne GermanyFaculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine University of Cologne GermanyMedical Clinic II University Heart Center Lübeck, University Hospital Schleswig‐Holstein Lübeck GermanyMedical Clinic II University Heart Center Lübeck, University Hospital Schleswig‐Holstein Lübeck GermanyAsklepios Westklinikum Hamburg Hamburg GermanyBackground Mitral valve transcatheter edge‐to‐edge repair (M‐TEER) has emerged as a viable therapy option in patients with severe mitral regurgitation and high surgical risk. Although atrial fibrillation is common among patients undergoing M‐TEER, the optimal anticoagulatory treatment after the intervention is unknown. Methods A single‐center retrospective observational analysis was conducted using data from the M‐TEER registry at the University Hospital Cologne collected from 2019 untill 2021 including patients undergoing M‐TEER between November 2012 and April 2019. Patients with atrial fibrillation receiving consistent anticoagulation following M‐TEER were categorized into a direct oral anticoagulant or a vitamin K antagonist (VKA) group. The primary end point was a composite of ischemic cerebrovascular and bleeding events. Additionally, overall survival was assessed. Results Among 613 patients undergoing M‐TEER, 206 met the inclusion criteria, with 61 receiving direct oral anticoagulants and 145 receiving VKAs. After a median follow‐up of 833 (interquartile range, 355–1271) days, the incidence of the composite primary end point did not differ between direct oral anticoagulant and VKA groups (hazard ratio [HR], 0.51 [95% CI, 0.23–1.12]; P=0.07). Similarly, rates of ischemic cerebrovascular events and bleeding events were similar between groups. However, the overall mortality rate was higher in the VKA group (HR, 2.56 [95% CI, 1.54–4.26]; P=0.002). In the multivariable analysis, oral anticoagulation with a VKA was an independent predictor for death (adjusted HR, 2.23 [95% CI, 1.08–5.06]; P=0.03). Conclusions Our findings suggest that direct oral anticoagulants may offer comparable efficacy and safety to VKAs in preventing thromboembolic events following M‐TEER in patients with atrial fibrillation. Further randomized trials are needed to confirm these results and establish optimal anticoagulation strategies in this patient population.https://www.ahajournals.org/doi/10.1161/JAHA.124.038834bleeding eventsdirect oral anticoagulantsmitral regurgitationmitral valve transcatheter edge‐to‐edge repairthromboembolic eventsvitamin K antagonists |
| spellingShingle | Jan‐Hendrik Schipper Anne‐Sophie Sommer Richard Julius Nies Clemens Metze Max Maria Meertens Jonas Wörmann Sebastian Dittrich Jan‐Hendrik van den Bruck Arian Sultan Jakob Lüker Daniel Steven Christopher Hohmann Roman Pfister Stephan Baldus Ingo Eitel Christian Frerker Tobias Schmidt Direct Oral Anticoagulants Versus Vitamin K Antagonists After Mitral Valve Transcatheter Edge‐to‐Edge Repair in Patients With Atrial Fibrillation: A Single‐Center Observational Study Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease bleeding events direct oral anticoagulants mitral regurgitation mitral valve transcatheter edge‐to‐edge repair thromboembolic events vitamin K antagonists |
| title | Direct Oral Anticoagulants Versus Vitamin K Antagonists After Mitral Valve Transcatheter Edge‐to‐Edge Repair in Patients With Atrial Fibrillation: A Single‐Center Observational Study |
| title_full | Direct Oral Anticoagulants Versus Vitamin K Antagonists After Mitral Valve Transcatheter Edge‐to‐Edge Repair in Patients With Atrial Fibrillation: A Single‐Center Observational Study |
| title_fullStr | Direct Oral Anticoagulants Versus Vitamin K Antagonists After Mitral Valve Transcatheter Edge‐to‐Edge Repair in Patients With Atrial Fibrillation: A Single‐Center Observational Study |
| title_full_unstemmed | Direct Oral Anticoagulants Versus Vitamin K Antagonists After Mitral Valve Transcatheter Edge‐to‐Edge Repair in Patients With Atrial Fibrillation: A Single‐Center Observational Study |
| title_short | Direct Oral Anticoagulants Versus Vitamin K Antagonists After Mitral Valve Transcatheter Edge‐to‐Edge Repair in Patients With Atrial Fibrillation: A Single‐Center Observational Study |
| title_sort | direct oral anticoagulants versus vitamin k antagonists after mitral valve transcatheter edge to edge repair in patients with atrial fibrillation a single center observational study |
| topic | bleeding events direct oral anticoagulants mitral regurgitation mitral valve transcatheter edge‐to‐edge repair thromboembolic events vitamin K antagonists |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.124.038834 |
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