AIM: To examine the risk of arterial thromboembolism, bleeding, and all-cause mortality in AF patients treated with direct oral anticoagulants (DOACs) versus vitamin K antagonists (VKAs) undergoing transcatheter aortic valve implantation (TAVI).

METHODS AND RESULTS: In this nationwide observational cohort study, 735 patients undergoing TAVI from January 1, 2012 to June 30, 2017 with a history of AF and who were treated with oral anticoagulants were identified using data from Danish nationwide registries. Of these, 219 (29.8%) and 516 (70.2%) patients were treated with DOACs and VKAs, respectively. The DOAC group was characterized by a higher prevalence of previous arterial thromboembolism and a lower prevalence of chronic kidney disease compared with the VKA group. The distribution of age, sex, CHA2DS2-VASc and HAS-BLED-score, and concomitant antiplatelet therapy was similar between groups. Compared with VKA, treatment with DOACs was not associated with a significantly different 3-year absolute risk of arterial thromboembolism (9.6% [95% confidence interval [CI], 4.7%-16.5%] versus 7.4% [95%CI, 4.9%-10.5%] in the DOAC and VKA group, respectively), bleeding (14.3% [95%CI, 7.6%-22.9%] versus 13.3% [95%CI, 9.9%-17.1%]), or all-cause mortality 32.7% [95%CI, 21.8%-44.0%] versus 32.0% [95%CI, 26.8%-37.3%]). In adjusted analyses, treatment with DOACs, as compared with VKAs, was not associated with a significantly different rate of arterial thromboembolism (hazard ratio [HR], 1.23 [95%CI, 0.58-2.59]), bleeding (HR, 1.14 [95%CI, 0.63-2.06]), or all-cause mortality (HR, 0.93 [95%CI, 0.61-1.40]).

CONCLUSIONS: In patients with AF undergoing TAVI, treatment with DOACs was not associated with a significantly different risk of arterial thromboembolism, bleeding, or all-cause mortality compared with VKA.