Abstract 17434: National Variation in Post-tavr Antithrombotic Therapy Utilization in Patients With Atrial Fibrillation: Insights From the Sts/acc Tvt Registry®

Abstract

Background: Oral anticoagulant and antiplatelet medications are routinely prescribed for patients with pre-operative atrial fibrillation (AF) after TAVR, however, there are no data on the optimal treatment strategy, or the patterns of medication use for these patients in the United States. Methods: Using the STS/ACC TVT Registry we evaluated patients with atrial fibrillation undergoing TAVR from 2011-2014. Clinical outcomes included death, bleeding, and stroke at 1 year of follow up. Results: Of the 10,514 patients in the TVT registry during this time period, 4540 patients (43%) had pre-existing AF. Of these, 52% (n=2348) of patients were discharged with an OAC (2226 on warfarin, 122 on dabigatran) and 48% (n=2192) of patients were discharged without an OAC, with substantial unadjusted hospital level variation (Figure). Patients discharged on OAC had concomitant ASA monotherapy most frequently (1461; 62%), but dual antiplatelet therapy (DAPT)(405; 17%), clopidogrel monotherapy (224; 9.5%), and no additional therapy (258; 11%) were also used. Patients discharged without OAC were most frequently discharged on DAPT (1401; 64%), though monotherapy (680; 31%), and no antiplatelet therapy (111; 5%) were also prescribed. Patients discharged on OAC compared with those not prescribed OAC were similar with respect to age (84 vs. 85 years), gender (50 vs. 49% female), and most comorbid illnesses, but had lower STS PROM risk scores (7.8 vs. 8.7), and were less likely to have renal failure (6.1 vs. 7.0%). Patients with AF undergoing TAVR had 1-year unadjusted rates of death (23.7%; 95% CI 22.3- 25.1%), bleeding (20.2%; 95% CI 18.8-21.6%), and stroke (3.8%; 95% CI 3.2-4.4%). Conclusions: Given the substantial variation in the patterns of antithrombotic therapy prescribed for US patients with AF post-TAVR and the 1-year rates of death, stroke, and bleeding observed, sustained effort is needed to determine the optimal antithrombotic medical therapy for these patients.