Abstract
Background
Patients with atrial fibrillation and bioprosthetic valves are at high risk for thromboembolic
events. The pooled efficacy and safety of non-vitamin K oral anticoagulants (NOACs),
as a class, relative to warfarin in this population is not well-known. We aimed to
compare the efficacy and safety of NOACs relative to warfarin in patients with bioprosthetic
valves or valve repair.
Methods
We systematically searched EMBASE, PubMed, and Cochrane databases for randomized controlled
trials comparing NOACs to warfarin in patients with atrial fibrillation and bioprosthetic
valves or valve repair. We pooled outcomes for stroke or systemic embolism, ischemic
stroke, hemorrhagic stroke, and major bleeding.
Results
We included 4 trials with 1379 patients, of whom 723 (52.4%) received a NOAC. Mean
follow-up ranged from 90 days to 2.8 years. In the pooled analysis, stroke or systemic
embolism was significantly lower in patients treated with NOACs (1.9%) compared with
warfarin (3.7%) (odds ratio [OR] 0.43; 95% confidence interval [CI] 0.22-0.85; P = .02). Ischemic stroke (OR 0.72; 95% CI 0.18-2.93), hemorrhagic stroke (OR 0.18;
95% CI 0.03-1.05), cardiovascular death (OR 0.78; 95% CI 0.38-1.62), and all-cause
mortality (OR 0.94; 95% CI 0.55-1.62) were not significantly different among groups.
Major bleeding was significantly lower in patients treated with NOAC (2.8%) compared
with warfarin (4.7%) (OR 0.49; 95% CI 0.28-0.88; P = .02).
Conclusions
In patients with atrial fibrillation and bioprosthetic valves or valve repair, NOACs
are associated with a reduced incidence of thromboembolic events and major bleeding
as compared with warfarin. Thus, NOACs may be considered a preferred option for this
patient population.
Keywords
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Article Info
Publication History
Published online: October 07, 2021
Footnotes
Funding: None.
Conflicts of Interest: RDL reports personal fees from Bayer, Boehringer Ingleheim, and Daiichi Sankyo; grants and personal fees from Bristol-Myers Squibb, Glaxo Smith Kline, Medtronic, Pfizer, and Sanofi; and personal fees from Merck and Portola, unrelated to this research. RC, CMPT, GBJ, AF, AVR, LK, AdA report none.
Authorship: All authors had access to the data and a role in writing the manuscript.
Identification
Copyright
© 2021 Published by Elsevier Inc.
