Cardiothoracic & vascular anaesthesia

Continuation versus Interruption of Oral Anticoagulation during transcatheter aortic-valve implantation (TAVI)

N Engl J MedPublished Randomised controlled trial

Primary resultResult — go to the resultRisk difference 1.7 percentage points 95% CI −3.1 to 6.6

Authors' conclusion

In patients undergoing TAVI with a concomitant indication for oral anticoagulation, periprocedural continuation was not noninferior to interruption of oral anticoagulation during TAVI with respect to the incidence of a composite of death from cardiovascular causes, stroke, myocardial infarction, major vascular complications, or major bleeding at 30 days.

Study context

Population
Patients receiving OAC and planning to undergo TAVImodified ITT population
Participants
858 patients
Comparison
Periprocedural continuation vs interruption of OAC during TAVI
  • Continuationn = 431
  • Interruptionn = 427reference
Primary endpoint
Composite of:
  • CV death
  • Stroke from any cause
  • MI
  • Major vascular complications
  • Major bleeding
Follow-up
30 days after TAVI
Methodological detailsinternational, open-label, non-inferiority
  • International
  • Open-label
  • Non-inferiority

Primary result

As reported in the abstract

Risk difference

1.7 percentage points

95% CI −3.1 to 6.6

P = 0.18 for non-inferiority

Events by treatment group

Continuation vs Interruption
risk difference 1.7 percentage points (95% CI −3.1 to 6.6); P for non-inferiority = 0.18

Further findings

OutcomeContinuationInterruptionRisk difference (percentage points) (95% CI)
Thromboembolic events8.8%8.2%0.6 (−3.1 to 4.4)

Safety

OutcomeContinuationInterruptionRisk difference (percentage points) (95% CI)
Bleeding31.1%21.3%9.8 (3.9–15.6)

Original publication

Continuation versus Interruption of Oral Anticoagulation during TAVI. N Engl J Med. Published 31 August 2024. doi:10.1056/nejmoa2407794

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