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

Introduction: Transcatheter edge to edge repair (TEER) with MitraClip^TM 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^TM 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^TM 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.