Effects of continuation versus interruption of oral anticoagulation during transcatheter aortic valve implantation on hemostasis function

Background One-third of patients undergoing transcatheter aortic valve implantation (TAVI) have a concomitant indication for oral anticoagulation (OAC). Previous studies suggested that periprocedural continuation of OAC could reduce transient hypercoagulation after TAVI. Objective To evaluate the effects of continuation versus interruption of OAC on periprocedural hemostasis function. Methods Patients were randomized 1:1 to OAC continuation vs interruption. Plasma samples were taken at 6 time points, and hemostasis function was assessed by measuring thrombin and plasmin generation, as well as biomarkers of coagulation, fibrinolysis, platelet activation, and endothelial function. Results A total of 167 patients were included: 82 were assigned to OAC continuation and 85 to OAC interruption. Pre-TAVI, a significantly lower endogenous thrombin potential (ETP) was observed in the continuation group compared with the interruption group. In both groups, ETP was reduced immediately post-TAVI, and its restoration was significantly lower in the continuation group. In contrast, levels of prothrombin fragment 1 + 2 were similar between the groups. A significantly lower endogenous plasmin potential was observed in the continuation group from pre-TAVI to 8 hours post-TAVI. In both groups, fibrin degradation products increased immediately post-TAVI, while this increase was significantly lower in the continuation group. Markers of endothelial and platelet activation were unaffected by the randomized strategy. Conclusion Continuation of OAC during TAVI modestly reduced the acute activation of coagulation and fibrinolysis compared with the interruption of OAC. This did not translate into any apparent differences in thromboembolic risk in the main trial. However, continuation of OAC resulted in a marked suppression of ETP and an increased risk of bleeding.