Effect of periprocedural anticoagulation on patient outcomes after transcatheter edge to edge repair of mitral valve with MitraClip; an insight from nationwide dataset.

INTRODUCTION

Transcatheter edge to edge repair (TEER) with MitraClip has been increasingly used after its FDA approval. Peri-procedural antithrombotic therapy is not yet clearly defined. We compared the outcomes of patients on anticoagulation with those on antiplatelets in this retrospective study.

METHODS

We identified 2,422 patients with MitraClip placement in Optum's de-identified Clinformatics® Data Mart Database from January 2016 to December 2020. Anticoagulation (AC group) were compared with dual antiplatelet (DAPT group). Patients were followed for 3 years. Primary outcome was occurrence of ischemic stroke, secondary outcomes were clinically significant bleeding requiring hospital visit and readmission within 30 days.

RESULTS

Of 2,422 patients, 957 (39.5 %) were on anticoagulation. Mean age was 79 + SD with 51 % males and 78 % Caucasians. Apixaban and aspirin were used in 486 (50.8 %) patients while 366 (38.24 %) patients used warfarin and aspirin. There was no statistically significant between groups difference in the incidence of stroke (HR 0.85, CI: 0.71-1.01, p = 0.07), clinically significant bleeding (HR 0.96, 95 % CI: 0.86-1.07, p = 0.46), or 30-days readmission rate (HR 1.07, 95 % CI: 0.84-1.36, p = 0.60). Subgroup analysis showed statistically significant benefit of using anticoagulation in atrial fibrillation patients (CI: 0.68-0.99, HR = 0.82, p = 0.04,). Heart failure was the most common cause of 30 days readmission.

CONCLUSION

DAPT has comparable results to anticoagulation after TEER with MitraClip in terms of stroke prevention, bleeding and 30-days readmission with the exception of patients with atrial fibrillation, who benefit from anticoagulation. Prospective studies are needed to clarify the importance of periprocedural anticoagulation and to reduce readmissions.