Meta-analysis of Direct Oral Anticoagulants in Patients With Atrial Fibrillation and Bioprosthetic Valves

In the presence of a surgical or transcatheter bioprosthetic valve, patients with atrial fibrillation are at increased risks of systemic thromboembolism.1 Although direct oral anticoagulants (DOACs) have been shown to be noninferior or superior to warfarin in preventing stroke or thromboembolism ass...

Full description

Saved in:
Bibliographic Details
Published in:The American journal of cardiology 2021-03, Vol.142, p.140-141
Main Authors: Kheiri, Babikir, Przybylowicz, Ryle, Simpson, Timothy F, Alhamoud, Hani, Osman, Mohammed, Dalouk, Khidir, Nazer, Babak, Henrikson, Charles A., Stecker, Eric
Format: Article
Language:English
Subjects:
Anticoagulants
Anticoagulants - therapeutic use
Atrial Fibrillation - complications
Atrial Fibrillation - drug therapy
Bioprosthesis
Bleeding
Cardiac arrhythmia
Cardiovascular disease
Clinical trials
Complications
Embolization
Factor Xa Inhibitors - therapeutic use
Fibrillation
Heart
Heart Valve Prosthesis
Heart valves
Humans
Meta-analysis
Mortality
Pharmacokinetics
Proportional Hazards Models
Safety
Stroke
Stroke - etiology
Stroke - prevention & control
Thromboembolism
Thromboembolism - etiology
Thromboembolism - prevention & control
Warfarin
Warfarin - therapeutic use
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:In the presence of a surgical or transcatheter bioprosthetic valve, patients with atrial fibrillation are at increased risks of systemic thromboembolism.1 Although direct oral anticoagulants (DOACs) have been shown to be noninferior or superior to warfarin in preventing stroke or thromboembolism associated with nonvalvular atrial fibrillation, the utilization of DOACs in patients with previous bioprosthetic valves has been limited in randomized clinical trials (RCTs).1 Therefore, we conducted a meta-analysis of all RCTs to assess the safety and efficacy of DOACs versus warfarin in this high-risk population. In the RE-ALIGN (Randomized, Phase II Study to Evaluate the Safety and Pharmacokinetics of Oral Dabigatran Etexilate in Patients after Heart Valve Replacement) trial, the use of dabigatran in patients with mechanical heart valves was associated with increased rates of thromboembolic and bleeding complications compared with warfarin, and resulted in premature termination of the trial.6 Therefore, current guidelines recommend against the use of DOACs in the presence of mechanical valve. [...]in patients with atrial fibrillation and bioprosthetic valves, DOAC use is noninferior to warfarin with respect to the incidence of stroke, systemic embolization, bleeding, and mortality.
ISSN:0002-9149
1879-1913
DOI:10.1016/j.amjcard.2020.12.006