scholarly journals Direct Oral Anticoagulants in Patients With Atrial Fibrillation and Valvular Heart Disease Other Than Significant Mitral Stenosis and Mechanical Valves

Circulation ◽  
2017 ◽  
Vol 135 (7) ◽  
pp. 714-716 ◽  
Author(s):  
Konstantinos C. Siontis ◽  
Xiaoxi Yao ◽  
Bernard J. Gersh ◽  
Peter A. Noseworthy
Keyword(s):  
Atrial Fibrillation ◽  
Heart Disease ◽  
Valvular Heart Disease ◽  
Mitral Stenosis ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Mechanical Valves

scholarly journals “A Tale of Two Cities”: Anticoagulation Management in Patients with Atrial Fibrillation and Prosthetic Valves in the Era of Direct Oral Anticoagulants

Medicina ◽  
2019 ◽  
Vol 55 (8) ◽  
pp. 437
Author(s):  
Giuseppe Palmiero ◽  
Enrico Melillo ◽  
Antonino Salvatore Rubino
Keyword(s):  
Atrial Fibrillation ◽  
Heart Disease ◽  
Valvular Heart Disease ◽  
Therapeutic Option ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Anticoagulation Management ◽  
Prosthetic Valves

Valvular heart disease and atrial fibrillation often coexist. Oral vitamin K antagonists have represented the main anticoagulation management for antithrombotic prevention in this setting for decades. Novel direct oral anticoagulants (DOACs) are a new class of drugs and currently, due to their well-established efficacy and security, they represent the main therapeutic option in non-valvular atrial fibrillation. Some new evidences are exploring the role of DOACs in patients with valvular atrial fibrillation (mechanical and biological prosthetic valves). In this review we explore the data available in the medical literature to establish the actual role of DOACs in patients with valvular heart disease and atrial fibrillation.

SAFETY AND EFFICACY OF DIRECT ORAL ANTICOAGULANTS IN PATIENTS WITH ATRIAL FIBRILLATION AND VALVULAR HEART DISEASE

2019 ◽  
Vol 73 (9) ◽  
pp. 501
Author(s):  
Matthew Lippmann ◽  
Nachiket Apte ◽  
Michael Pierpoline ◽  
Siva Sagar Taduru ◽  
Seyed Hamed Hosseini Dehkordi ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Heart Disease ◽  
Valvular Heart Disease ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Safety And Efficacy

scholarly journals Comparison of the Direct Oral Anticoagulants and Warfarin in Patients With Atrial Fibrillation and Valvular Heart Disease: Updated Systematic Review and Meta-Analysis of Randomized Controlled Trials

2021 ◽  
Vol 8 ◽  
Author(s):  
Yasmin de Souza Lima Bitar ◽  
Andre Rodrigues Duraes ◽  
Leonardo Roever ◽  
Mansueto Gomes Neto ◽  
Liliane Lins-Kusterer ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Systematic Review ◽  
Heart Disease ◽  
Major Bleeding ◽  
Valvular Heart Disease ◽  
Meta Analysis ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Risk Of Bias ◽  
Efficacy And Safety

Background: Direct oral anticoagulants (DOACS) are approved for use in non-valvular atrial fibrillation (AF). This systematic review and meta-analysis aimed to evaluate the efficacy and safety of DOACs vs. warfarin and update the evidence for treatment of AF and valvular heart disease (VHD).Methods: We identified randomized clinical trials (RCTs) and post-hoc analyses comparing the use of DOACS and Warfarin in AF and VHD, including biological and mechanical heart valves (MHV), updating from 2010 to 2020. Through systematic review and meta-analysis, by using the “Rev Man” program 5.3, the primary effectiveness endpoints were stroke and systemic embolism (SE). The primary safety outcome was major bleeding, while the secondary outcome included intracranial hemorrhage. We performed prespecified subgroup analyses. Data were analyzed by risk ratio (RR) and 95% confidence interval (CI) and the I-square (I2) statistic as a quantitative measure of inconsistency. Risk of bias and methodological quality assessment of included trials was evaluated with the modified Cochrane risk-of-bias tool.Results: We screened 326 articles and included 8 RCTs (n = 14.902). DOACs significantly reduced the risk of stroke/SE (RR 0.80, 95% CI: 0.68–0.94; P = 0.008; moderate quality evidence; I2 = 2%) and intracranial hemorrhage (RR 0.40, 95% CI: 0.24–0.66; P = 0.0004; I2 = 49%) with a similar risk of major bleeding (RR 0.83, 95% CI: 0.56–1.24; P = 0.36; I2 = 88%) compared to Warfarin.Conclusions: In this update, DOACs remained with similar efficacy and safety compared to warfarin in thromboprophylaxis for AF and VHD.

Oral anticoagulants in atrial fibrillation with valvular heart disease and bioprosthetic heart valves

Heart ◽  
2019 ◽  
Vol 105 (18) ◽  
pp. 1432-1436 ◽  
Author(s):  
Aaqib H Malik ◽  
Srikanth Yandrapalli ◽  
Wilbert S Aronow ◽  
Julio A Panza ◽  
Howard A Cooper
Keyword(s):  
Atrial Fibrillation ◽  
Heart Disease ◽  
Major Bleeding ◽  
Valvular Heart Disease ◽  
Heart Valves ◽  
Meta Analysis ◽  
Oral Anticoagulants ◽  
Cardiac Events ◽  
Increased Risk ◽  
Randomised Controlled

ObjectiveCurrent guidelines endorse the use of non-vitamin K antagonist oral anticoagulants (NOACs) in patients with atrial fibrillation (AF). However, little is known about their safety and efficacy in valvular heart disease (VHD). Similarly, there is a paucity of data regarding NOACs use in patients with a bioprosthetic heart valve (BPHV). We, therefore, performed a network meta-analysis in the subgroups of VHD and meta-analysis in patients with a BPHV.MethodsPubMed, Cochrane and Embase were searched for randomised controlled trials. Summary effects were estimated by the random-effects model. The outcomes of interest were a stroke or systemic embolisation (SSE), myocardial infarction (MI), all-cause mortality, major adverse cardiac events, major bleeding and intracranial haemorrhage (ICH).ResultsIn patients with VHD, rivaroxaban was associated with more ICH and major bleeding than other NOACs, while edoxaban 30 mg was associated with least major bleeding. Data combining all NOACs showed a significant reduction in SSE, MI and ICH (0.70, [0.57 to 0.85; p<0.001]; 0.70 [0.50 to 0.99; p<0.002]; and 0.46 [0.24 to 0.86; p<0.01], respectively). Analysis of 280 patients with AF and a BPHV showed similar outcomes with NOACs and warfarin.ConclusionsNOACs performed better than warfarin for a reduction in SSE, MI and ICH in patients with VHD. Individually NOACs performed similarly to each other except for an increased risk of ICH and major bleeding with rivaroxaban and a reduced risk of major bleeding with edoxaban 30 mg. In patients with a BPHV, results with NOACs seem similar to those with warfarin and this needs to be further explored in larger studies.

scholarly journals Rivaroxaban is Comparable to Warfarin in Prevention of Thromboembolism in Patients with Non-Valvular Atrial Fibrillation with Valvular Heart Disease: A Systematic Review and Meta-analysis

2021 ◽  
Author(s):  
Nischit Baral ◽  
Anjan Katel ◽  
Govinda Adhikari ◽  
Mahin R Khan ◽  
Hafiz M. W. Khan ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Heart Disease ◽  
Valvular Heart Disease ◽  
Meta Analysis ◽  
Oral Anticoagulants ◽  
Cochrane Collaboration ◽  
Test Results ◽  
Warfarin Group ◽  
Haenszel Test ◽  
Review Manager

Objectives: While the use of novel oral anticoagulants (NOACs) has been approved in the treatment of non-valvular atrial fibrillation (NVAF), we are lacking studies on individual NOACs in NVAF with valvular heart disease (VHD) including bio-prosthetic valve and valve repair. We aimed to determine the efficacy and safety of rivaroxaban compared to warfarin in prevention of thromboembolism in patients with NVAF with VHD. Methods: We searched PubMed, MEDLINE, and EMBASE including only RCTs and Cohort studies from inception till April 2021. Eligible studies compared rivaroxaban with warfarin in patients with NVAF with VHD. We excluded patients with valvular AF. We used Review Manager (version 5.4, Cochrane Collaboration, Oxford, UK) applying the Mantel-Haenszel test and followed PRISMA guidelines. Risk ratio (RR) and 95% confidence intervals (CIs) were estimated using a random-effects method and heterogeneity using I squared test. Results: We had total of 23136 participants in both groups. Our results showed stroke and systemic thromboembolism in 88 of 4258 (2.06%) patients in the rivaroxaban group compared to 351 of 18878 (1.85%) patients in the warfarin group (RR 0.76; 95% CI, 0.55, 1.06; heterogeneity I2 = 35%, P = 0.10), major bleeding in 247 of 4258 (5.8%) patients in the rivaroxaban group compared to 270 of 18879 (1.4%) patients in the warfarin group (HR 1.68; 95% CI, 0.59, 4.77; heterogeneity I2 = 97%) and intracranial hemorrhage in 24 out of 2583 (0.9%) patients in the rivaroxaban group compared to 35 of 2160 (1.6%) in warfarin group (HR 0.49; 95% CI, 0.16, 1.56; heterogeneity I2 = 70%). Conclusions: Our results show that rivaroxaban is comparable to warfarin in prevention of stroke and systemic thromboembolism in patients with NVAF with VHD. Rivaroxaban is also comparable to warfarin in bleeding risks in these patients.

scholarly journals Subtypes of atrial fibrillation with concomitant valvular heart disease derived from electronic health records: phenotypes, population prevalence, trends and prognosis

EP Europace ◽  
2019 ◽  
Vol 21 (12) ◽  
pp. 1776-1784 ◽  
Author(s):  
Amitava Banerjee ◽  
Victoria Allan ◽  
Spiros Denaxas ◽  
Anoop Shah ◽  
Dipak Kotecha ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Heart Disease ◽  
Aortic Stenosis ◽  
Valvular Heart Disease ◽  
Absolute Risk ◽  
Composite Endpoint ◽  
Population Based ◽  
Cox Models ◽  
Mechanical Valves ◽  
Electronic Health

Abstract Aims To evaluate population-based electronic health record (EHR) definitions of atrial fibrillation (AF) and valvular heart disease (VHD) subtypes, time trends in prevalence and prognosis. Methods and results A total of 76 019 individuals with AF were identified in England in 1998–2010 in the CALIBER resource, linking primary and secondary care EHR. An algorithm was created, implemented, and refined to identify 18 VHD subtypes using 406 diagnosis, procedure, and prescription codes. Cox models were used to investigate associations with a composite endpoint of incident stroke (ischaemic, haemorrhagic, and unspecified), systemic embolism (SSE), and all-cause mortality. Among individuals with AF, the prevalence of AF with concomitant VHD increased from 11.4% (527/4613) in 1998 to 17.6% (7014/39 868) in 2010 and also in individuals aged over 65 years. Those with mechanical valves, mitral stenosis (MS), or aortic stenosis had highest risk of clinical events compared to AF patients with no VHD, in relative [hazard ratio (95% confidence interval): 1.13 (1.02–1.24), 1.20 (1.05–1.36), and 1.27 (1.19–1.37), respectively] and absolute (excess risk: 2.04, 4.20, and 6.37 per 100 person-years, respectively) terms. Of the 95.2% of individuals with indication for warfarin (men and women with CHA2DS2-VASc ≥1 and ≥2, respectively), only 21.8% had a prescription 90 days prior to the study. Conclusion Prevalence of VHD among individuals with AF increased from 1998 to 2010. Atrial fibrillation associated with aortic stenosis, MS, or mechanical valves (compared to AF without VHD) was associated with an excess absolute risk of stroke, SSE, and mortality, but anticoagulation was underused in the pre-direct oral anticoagulant (DOAC) era, highlighting need for urgent clarity regarding DOACs in AF and concomitant VHD.

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