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Periprocedural Continuation Versus Interruption of Oral Anticoagulant Drugs During Transcatheter Aortic Valve Implantation (POPular PAUSE TAVI)

S

St. Antonius Hospital

Status and phase

Completed
Phase 4

Conditions

Stroke
Aortic Valve Stenosis
Vascular Complications
Aortic Valve Disease
Myocardial Infarction
Thrombosis Embolism
Bleeding

Treatments

Drug: Interruption of oral anticoagulants
Drug: Continuation of oral anticoagulants

Study type

Interventional

Funder types

Other

Identifiers

NCT04437303
NL73805.100.20

Details and patient eligibility

About

Transcatheter aortic valve implantation (TAVI) is a rapidly growing treatment option for patients with aortic valve stenosis. Stroke is a feared complication of TAVI, with an incidence of around 4-5% in the first 30 days. Up to 50% of patients undergoing TAVI have an indication for oral anticoagulants (OAC) mostly for atrial fibrillation. OAC use during TAVI could increase bleeding complications, but interruption during TAVI may increase the risk for thromboembolic events (i.e. stroke, systemic embolism, myocardial infarction). Recent observational data suggest that periprocedural continuation of OAC is safe and might decrease the risk of stroke. Beside the potential reduction of thromboembolic events, continuation of OAC is associated with an evident clinical ancillary benefit for patients and staff. Since periprocedural OAC interruption not infrequently leads to misunderstanding and potentially dangerous situations, when patients are not properly informed before hospital admission or may experience difficulties with the interruption regimen.

Hypothesis:

Periprocedural continuation of oral anticoagulants is safe and might decrease thromboembolic complications without an increase in bleeding complications at 30 days

Enrollment

858 patients

Sex

All

Ages

18+ years old

Volunteers

No Healthy Volunteers

Inclusion criteria

  • Planned transfemoral or transsubclavian transcatheter aortic valve implantation procedure
  • Uses oral anticoagulation at screening
  • Provided written informed consent

Exclusion criteria

Patients at high risk for thromboembolism for whom interruption of oral anticoagulants is no option, i.e.:

  • Mechanical heart valve prosthesis
  • Intracardiac thrombus
  • < 3 months after venous thromboembolism
  • < 6 months after transient ischemic attack or stroke in patients with atrial fibrillation

Trial design

Primary purpose

Prevention

Allocation

Randomized

Interventional model

Parallel Assignment

Masking

Single Blind

858 participants in 2 patient groups

Continuation of oral anticoagulants
Active Comparator group
Treatment:
Drug: Continuation of oral anticoagulants
Interruption of oral anticoagulants
Active Comparator group
Treatment:
Drug: Interruption of oral anticoagulants

Trial contacts and locations

22

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Central trial contact

Dirk-Jan van Ginkel, MD; Wilbert Bor, MD

Data sourced from clinicaltrials.gov

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