Evidence map›Paper›PMID 33877866›Full record

ArticleCirculation. Cardiovascular interventions2021

Variation in Antithrombotic Therapy and Clinical Outcomes in Patients With Preexisting Atrial Fibrillation Undergoing Transcatheter Aortic Valve Replacement: Insights From the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry.

Matthew W Sherwood, Aakriti Gupta, Sreekanth Vemulapalli, Zhuokai Li, Jonathan Piccini, J Kevin Harrison, David Dai, Amit N Vora, Michael J Mack, David R Holmes and 5 more

Open access · bronzeAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Circulation. Cardiovascular interventions, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed, 1 pooled it
1.4field-weighted citation impact, top 18% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed, 1 synthesis or guideline pooled it, 11 citations in OpenAlex.

  1. Pooled it
  2. Outcomes after TAVI in patients with atrial fibrillation and a history of recent PCI: Results from the ENVISAGE-TAVI AF trial.Clinical research in cardiology : official journal of the German Cardiac Society · 2025
    Trial
  3. Article
  4. Article
  5. Review
  6. DOACs in Mechanical and Bioprosthetic Heart Valves: A Narrative Review of Emerging Data and Future Directions.Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis
    Review
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

15 authors at 9 institutions in 1 country.

Matthew W Sherwood *Duke Clinical Research Institute, Durham, NC (M.W.S., S.V., Z.L., J.P., J.K.H., A.N.V., E.D.P.).
Aakriti Gupta *Section of Cardiovascular Medicine, Department of Medicine, Columbia University Irving Medical Center, New York, NY (A.G., A.J.K.).
Sreekanth VemulapalliDuke Clinical Research Institute, Durham, NC (M.W.S., S.V., Z.L., J.P., J.K.H., A.N.V., E.D.P.).
Zhuokai LiDuke Clinical Research Institute, Durham, NC (M.W.S., S.V., Z.L., J.P., J.K.H., A.N.V., E.D.P.).
Jonathan PicciniDuke Clinical Research Institute, Durham, NC (M.W.S., S.V., Z.L., J.P., J.K.H., A.N.V., E.D.P.).
J Kevin HarrisonDuke Clinical Research Institute, Durham, NC (M.W.S., S.V., Z.L., J.P., J.K.H., A.N.V., E.D.P.).
David DaiDivision of Cardiology, Duke University Medical Center, Durham, NC (S.V., J.P., D.D., A.N.V., E.D.P.).
Amit N VoraDuke Clinical Research Institute, Durham, NC (M.W.S., S.V., Z.L., J.P., J.K.H., A.N.V., E.D.P.).
Michael J MackDepartment of Cardiovascular Surgery, Baylor Scott & White Health, Plano, TX (M.J.M.).
David R HolmesDepartment of Cardiology, Mayo Foundation, Rochester, MN (D.R.H.).
John S RumsfeldDivision of Cardiology, Department of Medicine, University of Colorado Denver, Aurora (J.S.R.).
David J CohenDepartment of Cardiology, University of Missouri-Kansas City School of Medicine (D.J.C.).
Vinod H ThouraniMedStar Heart and Vascular Institute/Georgetown University, Washington, DC (V.H.T.).
Ajay J KirtaneSection of Cardiovascular Medicine, Department of Medicine, Columbia University Irving Medical Center, New York, NY (A.G., A.J.K.).
Eric D PetersonDuke Clinical Research Institute, Durham, NC (M.W.S., S.V., Z.L., J.P., J.K.H., A.N.V., E.D.P.).
Duke University · USClinical Research Institute · USColumbia University Irving Medical Center · USGeorgetown University · USHeart Hospital Baylor Plano · USMayo Clinic · USUniversity of Colorado Denver · USUniversity of Missouri–Kansas City · USYale New Haven Hospital · US

Funding

POSTDOCTORAL TRAINING IN CARDIOVASCULAR DISEASET32HL007854 · NHLBI · COLUMBIA UNIVERSITY HEALTH SCIENCES · PI Marwah Abdalla, Michael Argenziano · 1996 to 2026
$14.7M
NHLBI NIH HHS L30 HL120183NHLBI NIH HHS T32 HL007854
6 · The paper itself

Abstract

backgroundOptimal antithrombotic management of patients with preexisting atrial fibrillation undergoing transcatheter aortic valve replacement is challenging given the need to balance the risk of bleeding and thromboembolism. We aimed to examine variation in care and association of antithrombotic therapies with 1-year outcomes of stroke, bleeding, and mortality in patients undergoing transcatheter aortic valve replacement with concomitant atrial fibrillation in the United States.

methodsPatients who underwent transcatheter aortic valve replacement with preexisting atrial fibrillation from November 2011 through September 2015 in the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy registry linked to the Medicare database were examined according to receipt of oral anticoagulants (OACs) or antiplatelet therapies (APTs) or a combination of these (OAC+APT) at discharge. To assess the associations of antithrombotic therapies with 1-year outcomes of stroke, bleeding, and mortality, we utilized inverse probability weighting for antithrombotic therapies and multivariable regression modeling to adjust for patient- and hospital-level variables.

resultsIn the 11 382 patients included in our study, 5833 (51.2%) were discharged on OAC+APT, 4786 (42.0%) on APT alone, and 763 (6.7%) on OAC alone. There was significant variability in discharge medication patterns, including 42% of patients discharged without OAC therapy. In adjusted analyses, the risk for all-cause mortality and stroke was not significantly different when comparing the 3 different antithrombotic strategies. Risk of bleeding was higher with OAC+APT compared with APT alone (hazard ratio, 1.16 [95% CI, 1.05–1.27]) and similar compared with OAC alone (hazard ratio, 1.17 [95% CI, 0.93–1.47]).

conclusionsThere was significant variability in discharge medication patterns across US sites in patients with atrial fibrillation undergoing transcatheter aortic valve replacement, including significant underuse of OAC in this high-risk cohort. The use of OAC+APT (versus OAC alone or APT alone) was not associated with a lower risk of stroke or mortality but was associated with increased risk of bleeding complications at 1 year compared with APT alone.

Indexed as

Aortic Valve StenosisAtrial FibrillationCardiologySurgeonsTranscatheter Aortic Valve ReplacementAgedAortic ValveFibrinolytic AgentsHumansMedicareRegistriesRisk FactorsTreatment OutcomeUnited StatesFibrinolytic Agentsatrial fibrillationcohort studieshospitalsprobabilitytranscatheter aortic valve replacement

Identifiers

PMID33877866
PMCPMC8300574
OpenAlexW3155264977

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.