Abstract 14354: Optimal Anticoagulation Use in Patients Undergoing Transcatheter Mitral Valve Replacement a Quest for More Data

Abstract

Background: Multiple studies have demonstrated an increased risk of valve thrombosis in patients with mitral valve prostheses. Data to guide decision-making in regards to the choice of anticoagulation agent and duration of the therapy is lacking. We present our single-center experience with oral anticoagulation use in patients undergoing transcatheter mitral valve replacement (TMVR). Methods: 32 patients underwent the TMVR procedure at our center from 1/1/2017 to 12/31/2020. Data points on baseline characteristics, STS-PROM, functional status (NYHA and KCCQ), baseline laboratory values, echocardiographic parameters (including LVEF, MV area, gradient, grading of MS, and MR was collected. We analyzed patterns of anticoagulation therapy including the type of agent, duration of therapy, and complications occurring related to anticoagulation use. Results: Our registry included 32 patients that underwent TMVR. 70.5 % were females, 96.8 % Caucasian with a mean NYHA class of 3.25. STS-PROM of 6.25 (5.56-9.43) and KCCQ score of 38.04 (SD 19.9). Out of 32 patients, 31 had retrievable data. Vitamin K antagonist (VKA) was used in 60 % (18), apixaban in 26.6 % (8), rivaroxaban in 16.6 % (3), and no anticoagulation was used in 0.03 % (1) of patients.74 % (22) of the patients were on anticoagulation at the time of TMVR for another indication. 33.3% (6) of patients on VKA suffered a complication such as gastrointestinal/genitourinary bleed, while 54.45% (6) of patients on DOAC reported similar complications. Conclusion: The choice of anticoagulant and optimal duration of anticoagulation in patients undergoing TMVR remains a gap in our evidence base. We present our single-center experience of anticoagulant use in this patient population. Further randomized studies are needed to address this knowledge gap.