# Impact of Anticoagulant Class on Long-Term Bioprosthesis Durability Following Transcatheter Aortic Valve Replacement

## TL;DR

This study found no significant difference in bioprosthetic valve durability between patients taking vitamin K antagonists and direct oral anticoagulants after aortic valve replacement.

## Contribution

The study provides new evidence on the long-term durability of bioprosthetic valves in patients on different anticoagulant classes.

## Key findings

- DOACs were not associated with a different risk of hemodynamic valve deterioration compared to VKAs after 4 years of follow-up.
- No significant differences were observed in bioprosthetic valve failure or aortic valve reintervention between the two anticoagulant groups.
- Echocardiographic follow-up showed similar trends in valve hemodynamics over time for both groups.

## Abstract

Vitamin K antagonists (VKAs) and direct oral anticoagulants (DOACs) have distinct biological properties that may differentially influence bioprosthetic valve durability following transcatheter aortic valve replacement. The aim of this study was to explore the effect of oral anticoagulation (OAC) class on bioprosthetic valve durability.

We analyzed the data of a prospective registry including 688 consecutive patients under OAC undergoing transcatheter aortic valve replacement between May 2007 and January 2024 who were alive at 1 year. The effect of OAC class was assessed using a propensity score-matched population (132 patients with VKA vs. 132 patients with DOAC). The primary endpoint was the occurrence of stage 2 or 3 hemodynamic valve deterioration according to Valve Academic Research Consortium-3 criteria.

In the propensity score-matched population, treatment with DOACs was not associated with a different risk of stage 2 or 3 hemodynamic valve deterioration compared to VKAs (subdistribution hazard ratio [sHR] 0.89; 95% CI 0.35-2.29; p = 0.808) after a median follow-up of 4 years (interquartile range: 3-5). No significant differences were observed for the risk of bioprosthetic valve failure (sHR 1.62; 95% CI 0.53-4.96; p = 0.401) or aortic valve reintervention (sHR 0.97; 95% CI 0.14-6.82; p = 0.981). Long-term echocardiographic follow-up showed similar evolution of hemodynamic parameters over time.

No significant differences were observed between VKAs and DOACs on valve durability outcomes. Further studies with longer follow-up, larger population, and randomized designs are warranted to confirm these findings.

•Vitamin K antagonists and direct oral anticoagulants have distinct biological profiles that may differently affect bioprosthetic valve durability after transcatheter aortic valve replacement.•This study evaluated the long-term impact of oral anticoagulation class on bioprosthetic valve durability.•After a median follow-up of 4 years, treatment with direct oral anticoagulants was not associated with a different risk of stage 2 or 3 hemodynamic valve deterioration, bioprosthetic valve failure, or aortic valve reintervention compared with vitamin K antagonists.•Longitudinal echocardiographic follow-up demonstrated comparable trends in valve hemodynamics over time between the 2 groups.•Further large-scale, randomized studies with extended follow-up are warranted to confirm these results.

Vitamin K antagonists and direct oral anticoagulants have distinct biological profiles that may differently affect bioprosthetic valve durability after transcatheter aortic valve replacement.

This study evaluated the long-term impact of oral anticoagulation class on bioprosthetic valve durability.

After a median follow-up of 4 years, treatment with direct oral anticoagulants was not associated with a different risk of stage 2 or 3 hemodynamic valve deterioration, bioprosthetic valve failure, or aortic valve reintervention compared with vitamin K antagonists.

Longitudinal echocardiographic follow-up demonstrated comparable trends in valve hemodynamics over time between the 2 groups.

Further large-scale, randomized studies with extended follow-up are warranted to confirm these results.