Single low-dose of apixaban in patients with atrial fibrillation after transcatheter aortic valve implantation

Abstract Introduction and objectives: A significant amount of patients undergoing transcatheter aortic valve implantation (TAVI) have an indication for oral anticoagulation due to atrial fibrillation. In these patients the bleeding risk is often high. The purpose of this study was to compare the clinical outcomes of patients treated with low doses of apixaban or the vitamin K antagonist (VKA) acenocumarol in this setting. Methods: Multicenter observational registry including patients treated after TAVI with low doses of apixaban (2.5 mg/12 hours) or VKA both without associated antiplatelet therapy. Propensity score matching was conducted to select 2 comparable cohorts. Data were gathered for 12 months following the procedure. Coprimary endpoints of efficacy (death, myocardial infarction, and stroke) and safety (bleeding BARC ≥ 2) were considered. Results: A total of 236 patients were included. They were divided into 2 comparable groups of 64 patients each. Only 19 patients (30%) strictly met the dose adjustment criteria for apixaban. The rate of death, myocardial infarction, and stroke was similar at the 12-month follow-up (12.5% with VKA vs 9.3% with apixaban, P = .5), but the rate of bleeding BARC ≥ 2 was significantly higher in the VKA group (7.8% vs 0%; P = .02). Most of the events seen in the apixaban group occurred in patients with incorrect dose titration. Conclusions: In this registry of patients treated with TAVI and atrial fibrillation the use of low-dose apixaban compared to VKA—both without antiplatelet agents—was associated to a lower rate of actionable bleeding and a similar rate of thrombotic events.