Association Between Direct Oral Anticoagulant Score and Bleeding Events in Patients With Atrial Fibrillation Following Transcatheter Aortic Valve Replacement: A Retrospective Multicenter Cohort Study
Authors: Harano Yoshihiro , Yamamoto Masanori , Shimura Tetsuro , Okubo Munenori , Koyama Yutaka , Yamaguchi Ryo , Kagase Ai , Tokuda Takahiro , Yashima Fumiaki , Shirai Shinichi , Tada Norio , Naganuma Toru , Yamawaki Masahiro , Yamanaka Futoshi , Mizutani Kazuki , Noguchi Masahiko , Ueno Hiroshi , Takagi Kensuke , Ohno Yohei , Izumo Masaki , Nishina Hidetaka , Asami Masahiko , Otsuka Toshiaki , Watanabe Yusuke , Hayashida Kentaro , Hayashida Kentaro , Tanaka Makoto , Tsuruta Hikaru , Saito Tetsuya , Kobari Yusuke , Ryuzaki Toshinobu , Takahashi Tatsuo , Goto Shinichi , Imaeda Shohei , Sakata Shingo , Katsumata Yoshinori , Shirakawa Kohsuke , Iwata Juri , Shinada Keitaro , Kajino Akiyoshi , Kato Jungo , Arita Ryo , Moriizumi Tomonari , Yamamoto Masanori , Sago Mitsuru , Tsunaki Tatsuya , Yamaguchi Ryo , Yanagisawa Junji , Okubo Yuki , Kagase Ai , Tokuda Takahiro , Nakashima Yuki , Kobayashi Toshihiro , Shibata Kenichi , Kawahata Ryoutaku , Nishio Hiroto , Kondo Yuki , Nakamura Tomofumi , Tsunamoto Hiroshi , Shimura Tetsuro , Koyama Yutaka , Okubo Munenori , Imai Shunsuke , Sakakura Tokuya , Harano Yoshihiro , Inagaki Masahiro , Higami Hirooki , Kuze Yoji , Nagai Takashi , Kurita Azusa , Shirai Shinichi , Isotani Akihiro , Ishizu Kenichi , Fukunaga Masato , Tabata Hiroyuki , Morofuji Toru , Kono Hiroyuki , Kuroda Maiko , Euihong Ko , Miyawaki Norihisa , Nakano Kenji , Miyahara Katsunori , Yamamoto Ko , Onuki Koumei , Tsuru Yasuo , Suenaga Tomohiro , Otani Akira , Watanabe Yusuke , Katayama Taiga , Hioki Hirofumi , Nishikawa Junichi , Iseki Yosei , Tsuchida Yasuyuki , Kito Kento , Omiya Joe , Arakawa Masataka , Okamoto Maki , Saito Masafumi , Miura Mizuki , Naganuma Toru , Ouchi Toru , Yuki Haruhito , Yamawaki Masahiro , Tada Norio , Enta Yusuke , Nakashima Masaki , Saigan Makoto , Munehisa Yoshiko , Miyasaka Masaki , Satomi Natsuko , Kobayashi Yuta , Tazawa Daishi , Teng Yun , Yamanaka Futoshi , Mizuno Shingo , Shishido Koki , Ochiai Tomoki , Yamabe Tsuyoshi , Moriyama Noriaki , Matsumoto Takashi , Miyashita Hirokazu , Sugiyama Yoichi , Shimizu Kunihiko , Sato Daisuke , Murakami Yuka , Noguchi Masahiko , Kato Nahoko , Ito Joji , Muraishi Makio , Azumi Yuta , Tabata Minoru , Yoshino Kunihiko , Kobayashi Tetsuya , Sakai Hiroki , Ueno Hiroshi , Fukuda Nobuyuki , Tanaka Shuhei , Onoda Hiroshi , Doi Toshio , Sobajima Mitsuo , Ueno Yohei , Imamura Teruhiko , Ushijima Ryuichi , Hida Yuki , Nakashima Kazuya , Ohno Yohei , Miyamoto Junichi , Murakami Tsutomu , Okada Kimiaki , Torii Sho , Natsumeda Makoto , Tanaka Shigemitu , Ijichi Takeshi , Horinouchi Hitomi , Aihara Kazuki , Sakai Katsuaki , Matsumoto Shingo , Kamioka Norihiko , Nakamura Norihito , Saito Takafumi , Noda Satoshi , Sato Yu , Izumo Masaki , Miyahara Daisuke , Kuwata Shingo , Koga Masashi , Kaihara Toshiki , Higuma Takumi , Honda Kei , Kobayashi Yoshikuni , Murata Risako , Sasaki Kenichi , Togashi Daisuke , Kai Takahiko , Okuno Taishi , Yoshida Toshiya , Sone Keita , Terauchi Karin , Yamasaki Kazumasa , Bota Hiroki , Tani Tomoyuki , Miyazaki Mamoru , Katagiri Yuki , Nishina Hidetaka , Kuwayama Akimune , Akiyama Daiki , Shinouchi Kazuya , Ishikawa Maiko , Suzuyama Hiroto , Kodama Kazuhisa , Okamatsu Hideharu , Sakamoto Tomohiro , Horibata Yoko , Konami Yutaka , Yamada Masahiro , Horio Eiji , Maeda Mika , Hasegawa Satoko , Koga Megumi , Ohara Mikiko , Fukushige Shota , Fuku Yasushi , Ikuta Akihiro , Matsushita Shunsuke , Oka Satoki , Inoue Naoya , Bando Gakuto , Takagi Kensuke , Amaki Makoto , Kitai Takeshi , Okada Atsushi , Hada Tasuku , Nakagawa Shoko , Arai Marina , Irie Yuki , Sakamoto Takahiro , Kurashima Shinichi , Asami Masahiko , Tanaka Jun , Horiuchi Yu , Hosoda Naoki , Gonda Yuki , Nishimura Yohei , Oshima Asahi , Yashima Fumiaki , Hashizume Kenichi , Nishida Hiroaki , Yoshijima Nobuhiro , Sato Masatoshi , Nakazawa Gaku , Yasuda Masakazu , Fujita Kosuke , Miyoshi Tatsuya , Soejima Naoko , Maruyama Masahiro , Tanaka Motohide , Kawamura Takayuki , Kanno Honoka , Yoshida Ayano , Onishi Kyohei , Yamada Nobuhiro , Matsuzoe Hiroki , Hachinohe Daisuke , Kobayashi Ken , Kaneko Umihiko , Mizutani Kazuki , Shitan Hidemasa , Horita Ryo , Otake Ryo 
Published: November 2024

Background
The Direct Oral Anticoagulant (DOAC) Score can predict bleeding risk in patients with atrial fibrillation taking DOACs; however, it lacks external validation. Therefore, this study aimed to assess the association between the DOAC Score and bleeding events in patients with atrial fibrillation who underwent transcatheter aortic valve replacement.

Methods and Results

This retrospective multicenter cohort study included patients with atrial fibrillation who underwent transcatheter aortic valve replacement, as registered in a Japanese multicenter registry. The primary end point was the incidence of bleeding. Patients were categorized based on their DOAC Score: low and moderate‐ (≤7 points), high‐ (8–9 points), and very high‐risk (≥10 points) groups. Among 1230 patients (mean age 84.6±5.1 years; 457 men), 465 (37.8%) received a vitamin K antagonist, and the remaining patients received DOACs. The low and moderate‐, high‐, and very high‐risk groups included 380 (30.1%), 497 (40.4%), and 353 patients (28.7%), respectively. The 3‐year cumulative incidence of all bleeding events was significantly different among the 3 groups (low and moderate risk: 6.6%, high risk: 6.9%, and very high risk: 14.0%;
P
<0.01). Multivariable Cox regression analysis revealed that significant increments in the DOAC Score were associated with a risk of all bleeding events at 3 years in the overall cohort (hazard ratio [HR], 1.22 [95% CI, 1.08–1.38];
P
<0.01), in the DOAC cohort (HR, 1.20 [95% CI, 1.01–1.42];
P
=0.04), and in the vitamin K antagonist cohort (HR, 1.25 [95% CI, 1.04–1.50];
P
=0.02).

Conclusions
The DOAC Score was significantly associated with bleeding events in patients with atrial fibrillation after transcatheter aortic valve replacement, aiding in clinical decision‐making for anticoagulant management.

Registration

URL:
https://center6.umin.ac.jp/cgi‐open‐bin/ctr_e/ctr_view.cgi?recptno=R000023585
; Unique identifier: UMIN000020423.