A three-month direct oral anticoagulant (DOAC) regimen shortly after successful TAVR substantially reduced hypoattenuated leaflet thickening (HALT) during treatment vs. single antiplatelet therapy (SAPT) alone, based on findings from the NOTION-4 trial presented at ESC Congress 2026 and simultaneously published in JACC. However, researchers noted that this effect was diminished around nine months following discontinuation of DOAC therapy.

Researchers randomized 352 patients without an indication for oral anticoagulation shortly after successful TAVR to either lifelong SAPT or three months of DOAC therapy followed by lifelong SAPT. The primary endpoint was HALT prevalence at 12 months.

At three months, HALT was observed in roughly 32% of patients in the SAPT group compared with 12% of those in the DOAC group. However, the difference between the two groups at one year based on patients with available CT scans was less significant (32% SAPT vs. 28% DOAC). Additionally, researchers noted that the combined risk of all-cause mortality, stroke, or major/life-threatening bleeding at 12 months was 2.3% in the SAPT group vs 8.2% in the DOAC group.

“Although the trial’s precisions at 12 months do not allow us to confirm or rule out a modest, sustained effect on HALT in the [DOAC] group, the serial cardiac CT scans suggest that the impact of short-term DOAC therapy on HALT is not permanent,” write Troels Højsgaard Jørgensen, MD, PhD, et al. “Moreover, because the short-term reduction in HALT with [three-month DOAC] was not associated with a clinical benefit – and clinical events occurred numerically more frequently in the DOAC group – our findings support current guidelines that recommend against the routine use of DOACs after TAVR in patients without another indication for oral anticoagulation.”

Visit the JACC Journals at ESC Congress 2026 page to see the full list of simultaneous publications.


Clinical Topics:
Cardiac Surgery, Cardiovascular Care Team, Invasive Cardiovascular Angiography and Intervention


Keywords:
ESC Congress, ESC26, Transcatheter Aortic Valve Replacement, Thrombosis, Heart Valve Prosthesis