Abstract
Introduction
Hypoattenuated leaflet thickening (HALT), as identified by CT imaging, is not infrequent
after transcatheter aortic valve implantation (TAVI). The best choice of oral anticoagulation
is unknown. We compared the effectiveness of Direct Oral AntiCoagulants (DOAC) and
Vitamin-K Antagonists (VKA) to resolve HALT in patients with serial CT aquisitions.
Methods
A total of 46 consecutive TAVI patients in whom anticoagulation had been initiated
because of HALT and who underwent follow-up CT were identified. Indication and type
of anticoagulation was according to physician discretion. Patients on DOAC were compared
to VKA therapy regarding resolution of HALT.
Results
Mean age of the 46 patients was 80 ± 6 years (59% men), and the mean duration of anticoagulation
was 156 days. Overall, 41 patients (89%) showed resolution of HALT with anticoagulation
therapy, whereas HALT persisted in 5 patients (11%). Resolution of HALT was seen in
26 out of 30 (87%) patients receiving VKA and in 15 out of 16 (94%) patients receiving
DOAC, respectively. Groups did not differ regarding age, cardiovascular risk factors,
TAVI prosthesis type and size or duration of anticoagulation (all p > 0.05).
Conclusion
Anticoagulation therapy resolves leaflet thickening after TAVI in most patients. Non-Vitamin-K
antagonists seem to be an effective alternative to Vitamin-K antagonists. This finding
needs to be confirmed in larger prospective trials.
Graphical abstract
Graphical Abstract
Keywords
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Article info
Publication history
Published online: May 25, 2023
Accepted:
May 17,
2023
Received in revised form:
May 12,
2023
Received:
February 5,
2023
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Elsevier B.V. All rights reserved.
