Bioprosthetic valves and atrial fibrillation: Direct anticoagulants or warfarin

In their article "Bioprosthetic Valves and Atrial Fibrillation: Direct Anticoagulants or Warfarin," and Svensson and Kapadia 1 review the current state of anticoagulation therapy for patients with atrial fibrillation and bioprosthetic valves. They describe the well-known limitations of warfarin and discuss a promising future of direct oral anticoagulants. The unfortunate conclusion: "further investigations and more data are warranted." It's hard to wait. The data in regard to time in therapeutic range for warfarin are sobering. Even in a registry population, likely to be superior to the general population, only 59% of international normalized ratios are in the therapeutic range, and those at greatest risk seem to be the least likely to be in the therapeutic range. 2 To get to even that mediocre success rate requires frequent testing, manipulation of dosing regimens, and restrictive diets-it is cumbersome and frustrating for both patients and clinicians. The consequences of suband supratherapeutic anticoagulation can be devastating, making the suboptimal success rate even more concerning. If warfarin were to be reviewed as a new drug by the Food and Drug Administration today, it almost certainly would not be approved for clinical use in humans, given its unpredictability with regard to dose and response. And, according to the internet, warfarin is not even a good rat poison anymore: "the use of warfarin in rat poison is now declining because many rat populations have developed resistance to it and much better poisons are now available." 3 Of course, warfarin's shortcomings cannot be used as an argument to approve novel agents in unproven circumstances. The prematurely terminated RE-ALIGN trial (Randomized, Phase

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Bioprosthetic valves and atrial fibrillation: Direct anticoagulants or warfarin

Cited by 4 publications

References 26 publications

An Evidence-Based Approach to Anticoagulation Therapy Comparing Direct Oral Anticoagulants and Vitamin K Antagonists in Patients With Atrial Fibrillation and Bioprosthetic Valves: A Systematic Review, Meta-Analysis, and Network Meta-Analysis

An Evidence-Based Approach to Anticoagulation Therapy Comparing Direct Oral Anticoagulants and Vitamin K Antagonists in Patients With Atrial Fibrillation and Bioprosthetic Valves: A Systematic Review, Meta-Analysis, and Network Meta-Analysis

Commentary: Direct oral anticoagulants in heart surgery: A question in need of an answer

Commentary: Anticoagulation strategies: Awaiting a new paradigm

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