Predictors and Outcomes of Inappropriate Dosing of Direct Oral Anticoagulants in Patients Receiving Transcatheter Aortic Valve Implantation

Danial Amoey; Mohamed Samy; Karim Elbasha; Ahmad Alali; Martin Landt; Arief Kurniadi; Holger Nef; Ralph Tölg; Gert Richardt; Nader Mankerious

doi:10.1007/s40119-024-00387-0

Predictors and Outcomes of Inappropriate Dosing of Direct Oral Anticoagulants in Patients Receiving Transcatheter Aortic Valve Implantation

Cardiol Ther. 2024 Dec;13(4):761-773. doi: 10.1007/s40119-024-00387-0. Epub 2024 Nov 4.

Authors

Danial Amoey¹, Mohamed Samy^{1

2}, Karim Elbasha^{1

2}, Ahmad Alali¹, Martin Landt¹, Arief Kurniadi¹, Holger Nef¹, Ralph Tölg^{1

3

4}, Gert Richardt^{1

3}, Nader Mankerious^{5

6}

Affiliations

¹ Heart Center, Segeberger Kliniken GmbH, Am Kurpark 1, 23795, Bad Segeberg, Germany.
² Cardiology Department, Zagazig University, Sharkia, Egypt.
³ Zentrum für Herz-, Gefäss- und Diabetesmedizin, Asklepios Klinik Bad Oldesloe, Bad Oldesloe, Germany.
⁴ Medizinische Fakultät der Christian-Albrechts-Universität zu Kiel, Kiel, Germany.
⁵ Heart Center, Segeberger Kliniken GmbH, Am Kurpark 1, 23795, Bad Segeberg, Germany. [email protected].
⁶ Cardiology Department, Zagazig University, Sharkia, Egypt. [email protected].

Abstract

Introduction: Direct oral anticoagulant (DOAC) dose adjustment is based on age, renal function, and body weight. There is a paucity of data describing the factors associated with the prescription of inappropriate dosage and their impact on clinical outcomes among patients receiving transcatheter aortic valve implantation (TAVI).

Methods: In a single-center study, 432 patients who were on long-term DOAC therapy and underwent TAVI between 2015 and 2022 were included. We analyzed the predictors and outcomes of inappropriate dosing of DOACs; namely apixaban, dabigatran, edoxaban, and rivaroxaban. A composite endpoint, including all-cause mortality, life-threatening/major bleeding, stroke, peripheral thromboembolic complications, or myocardial infarction, was assessed after 1 year.

Results: In this TAVI cohort, inappropriate DOAC dosing was observed in 20.6% of patients. Inappropriate DOAC dosage was related to female gender (adj. odds ratio [OR] 2.72, 95% confidence interval [CI] 1.64-4.51, p < 0.001) as well as lower estimated glomerular filtration rate (eGFR) (adj. OR 0.99, 95% CI 0.98-1.00, p = 0.019), and to the administration of non-rivaroxaban DOACs (adj. OR 0.28, 95% CI 0.16-0.50, p < 0.001). After 1 year, patients on both appropriate and inappropriate DOAC dosage exhibited comparable rates of the composite endpoint (OR 0.88, 95% CI 0.53-1.46, p = 0.622). Old age (adj. OR 1.05, 95% CI 1.01-1.10, p = 0.018) as well as anemia (adj. OR 0.86, 95% CI 0.75-0.99, p = 0.031) emerged as independent predictors of the composite endpoint.

Conclusions: In this TAVI cohort, female gender and renal insufficiency were associated with inappropriate DOAC dosage, whereas rivaroxaban was linked to appropriate dosing. Inadequate DOAC dosage did not translate into a worse outcome in our TAVI population.

Trial registration: Prospective Segeberg TAVI Registry (ClinicalTrials.gov identifier: NCT03192774).

Keywords: Direct oral anticoagulant (DOAC); New oral anticoagulant (NOAC); Transcatheter aortic valve implantation (TAVI); Transcatheter aortic valve replacement (TAVR).

Associated data

ClinicalTrials.gov/NCT03192774