DOACs vs VKAs: Which Are Safer for Patients Undergoing TAVI?

Direct oral anticoagulants (DOACs) and vitamin K antagonists (VKAs) yield similar safety results among patients undergoing transcatheter aortic valve implantation (TAVI) with concomitant indication of oral anticoagulation, according to results of a new meta-analysis.

To reach this conclusion, the researchers searched the PubMed and Embase databases through October 2019 for studies that had compared the safety of DOACs and VKAs among this patient population. 

In all, the researchers analyzed data from 5 eligible studies that included 2569 participants—a majority of whom had atrial fibrillation as the indication for anticoagulation use.

While the main efficacy outcomes were all-cause mortality and stroke, the main safety outcome was major and/or life-threatening bleeding. 

The researchers found no significant differences in all-cause mortality, major and/or life-threatening bleeding, or stroke between patients treated with DOACs vs VKAs.

“Further large scale randomized controlled trials are needed to search the optimal oral anticoagulation regimen in this population,” the researchers concluded.

—Colleen Murphy


Ueyama H, Kuno T, Ando T, et al. Meta-analysis comparing direct oral anticoagulants versus vitamin K antagonists after transcatheter aortic valve implantation. Am J Cardiol. 2020;125(7):1102-1107. doi:10.1016/j.amjcard.2019.12.039