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<p>The optimal timing of oral anticoagulation (OAC) initiation after transcatheter aortic valve replacement (TAVR) in patients with atrial fibrillation remains uncertain. This study compared early (within 2 days) versus delayed (5–7 days) OAC initiation on clinical outcomes in this population. In this retrospective cohort study using the TriNetX US Collaborative Network (data through 2024), we identified patients aged ≥ 18 years with atrial fibrillation or flutter undergoing TAVR via percutaneous femoral approach. Patients were categorized by OAC initiation timing post-TAVR. The index date was the TAVR procedure day; outcomes were assessed at 30 days, 90 days, and 1 year. Analyses used risk ratios (RRs), hazard ratios (HRs), Kaplan–Meier curves, and log-rank tests. After 1:1 propensity score matching, 3,372 patients remained in each cohort. Early OAC was associated with lower net adverse clinical events (NACE; all-cause mortality, stroke, arterial embolism or thrombosis, or major hemorrhage including transfusion) at 30 days (RR 0.754, 95% CI 0.683–0.832, <i>p</i> &lt; 0.001), 90 days (RR 0.780, 95% CI 0.719–0.846, <i>p</i> &lt; 0.001), and 1 year (RR 0.839, 95% CI 0.789–0.893, <i>p</i> &lt; 0.001). All-cause mortality, major hemorrhage, and acute kidney injury were also significantly reduced with early OAC across all time points. Corresponding hazard ratios confirmed sustained benefit (30-day NACE HR 0.74, 95% CI 0.66–0.82; 1-year HR 0.79, 95% CI 0.73–0.85). Early OAC initiation within 2 days after TAVR was associated with lower NACE, mortality, hemorrhage, and acute kidney injury compared with initiation at 5–7 days in patients with atrial fibrillation. Prospective trials are warranted to confirm these findings.</p> Graphical abstract <p></p>

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Early versus delayed oral anticoagulation initiation after transcatheter aortic valve replacement in patients with atrial fibrillation: a retrospective cohort study

  • 期刊论文

  • 发表日期：

    2026年7月25日

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  • Muneeb Khawar,
  • Mohab Elnashar,
  • Mirza Muhammad Hadeed Khawar,
  • Mohammad Azeem Malik,
  • Shameer Iqbal Ghuman,
  • Awon Muhammad,
  • Mohammad Maheer Mubashir,
  • Gul Sher Ghouri,
  • Abdullah Shahid,
  • Ashesh Das

摘要

The optimal timing of oral anticoagulation (OAC) initiation after transcatheter aortic valve replacement (TAVR) in patients with atrial fibrillation remains uncertain. This study compared early (within 2 days) versus delayed (5–7 days) OAC initiation on clinical outcomes in this population. In this retrospective cohort study using the TriNetX US Collaborative Network (data through 2024), we identified patients aged ≥ 18 years with atrial fibrillation or flutter undergoing TAVR via percutaneous femoral approach. Patients were categorized by OAC initiation timing post-TAVR. The index date was the TAVR procedure day; outcomes were assessed at 30 days, 90 days, and 1 year. Analyses used risk ratios (RRs), hazard ratios (HRs), Kaplan–Meier curves, and log-rank tests. After 1:1 propensity score matching, 3,372 patients remained in each cohort. Early OAC was associated with lower net adverse clinical events (NACE; all-cause mortality, stroke, arterial embolism or thrombosis, or major hemorrhage including transfusion) at 30 days (RR 0.754, 95% CI 0.683–0.832, p < 0.001), 90 days (RR 0.780, 95% CI 0.719–0.846, p < 0.001), and 1 year (RR 0.839, 95% CI 0.789–0.893, p < 0.001). All-cause mortality, major hemorrhage, and acute kidney injury were also significantly reduced with early OAC across all time points. Corresponding hazard ratios confirmed sustained benefit (30-day NACE HR 0.74, 95% CI 0.66–0.82; 1-year HR 0.79, 95% CI 0.73–0.85). Early OAC initiation within 2 days after TAVR was associated with lower NACE, mortality, hemorrhage, and acute kidney injury compared with initiation at 5–7 days in patients with atrial fibrillation. Prospective trials are warranted to confirm these findings.

Graphical abstract