Clinical Benefit of Direct Oral Anticoagulants Versus Vitamin K Antagonists in Patients with Atrial Fibrillation and Bioprosthetic Heart Valves

Russo, Vincenzo; Carbone, Andreina; Attena, Emilio; Rago, Anna; Mazzone, Carmine; Proietti, Riccardo; Parisi, Valentina; Scotti, Andrea; Nigro, Gerardo; Golino, Paolo; D’Onofrio, Antonio

doi:10.1016/j.clinthera.2019.10.008

Cited by 45 publications

(31 citation statements)

References 25 publications

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“…9 Considering the heterogeneity of the "non- valvular" definition and the variable inclusion criteria of the 4 pivotal trials on DOACs, the terms "non-MARM valvular AF" and Evaluated Heartvalves, Rheumatic or Artificial (EHRA) type 2 VHD have also been proposed to clearly identify AF patients with valvular disease who could benefit from DOACs therapy. 5,10 Despite growing real-world evidence suggesting a favorable clinical profile in patients with bioprosthetic heart valves, 11,12 the real-world benefit of DOACs in patients with non-MARM valvular AF or EHRA type 2 VHD remains an important unfocused clinical issue not definitively addressed. Four main RCTs have included a variable proportion of AF patients with VHD, [13][14][15][16] with MR being the most represented (>70%) valvular disease subtype.…”

Section: Discussionmentioning

confidence: 99%

Atrial Fibrillation and Mitral Regurgitation: Clinical Performance of Direct Oral Anticoagulants in a Real-World Setting

Melillo

Rago

Proietti

et al. 2020

J Cardiovasc Pharmacol Ther

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Background: Atrial fibrillation (AF) is the most common cardiac arrhythmia and is frequently present in patients with mitral regurgitation (MR). Currently, there is a lack of real-world evidence specifically addressing the clinical performance of direct oral anticoagulants (DOACs) in patients with AF and concomitant MR. Therefore, the aim of the present study was to assess the efficacy and safety profile of DOACs therapy in patients with AF and MR. Methods: Data for this study were sourced from the Atrial Fibrillation Research Database in the Department of Cardiology at Monaldi Hospital. The database was queried for AF patients with MR who were prescribed DOACs therapy. The primary safety outcome was defined as the annual incidence rate of major bleeding events and the primary effectiveness outcome as the annual incidence rate of all events classified as ischemic stroke, transient ischemic attacks, and systemic embolisms. Results: Consecutive AF patients with concomitant mild to severe MR who received DOACs therapy (n = 259) were included. Patients were dichotomized in 2 groups according to MR severity: a mild-to-moderate group (MR 1-2+; n = 151) and a moderate-to-severe group (MR 3-4+; n = 108). The incidence rate of major bleedings was significantly higher in MR 3-4+ group (3.92%) compared with the MR 1-2+ group (1.18%; hazard ratio [HR]: 3.2; 95% CI: 1.4-7.3; P = .0059). The incidence rate of thromboembolic events between MR 3-4+ group (0.66%) and MR 1-2+ group (0.62%) was not significantly different (HR: 0.75; P = .823). Conclusions: In the present study, there was no difference in the efficacy profile of DOACs between AF patients with mild-to-moderate and moderate-to-severe MR. Considering the increased bleeding risk, a close and careful follow-up should be warranted for patients with moderate-to-severe MR.

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Section: Discussionmentioning

confidence: 99%

Atrial Fibrillation and Mitral Regurgitation: Clinical Performance of Direct Oral Anticoagulants in a Real-World Setting

Melillo

Rago

Proietti

et al. 2020

J Cardiovasc Pharmacol Ther

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“…63 Guimarães et al 64 and Durães et al 65 assessed the use of the DOACs dabigatran and apixaban respectively, against warfarin and determined that there were no differences in the incidence of thromboembolic events between the groups. 5 On the other hand, Russo et al 66 suggested that patients on a range of DOACs had a greater net clinical benefit than those taking VKAs as they had a lower incidence of thromboembolic events and major bleeds, though none of these findings were statistically significant. Carnicelli et al 67 also concluded that the incidence of the primary net clinical outcome (defined as a combination of stroke, systemic embolic events, major bleeds, and death) was significantly lower in patients taking either high dose (60 mg) or low dose (30 mg) edoxaban when compared to those taking warfarin.…”

Section: Direct Oral Anticoagulantsmentioning

confidence: 99%

Anticoagulation and antiplatelet therapy in patients with prosthetic heart valves

et al. 2020

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Background: The choice of antithrombotic therapy, anticoagulants or antiplatelets, after prosthetic heart valve replacement or repair, remains a disputed topic in the literature. Antithrombotic therapies are used after heart valve intervention to reduce the rates of thromboembolic events, therefore improving patient outcomes. Different interventions may require different therapeutic regimens to achieve the most efficacious clinical outcome for patients. Methods and Discussion: This review aims to summarize and critique the available literature concerning therapeutic agents used for bioprosthetic and mechanical valves as well as for valve repair, so as to assist clinicians and researchers in making decisions with regard to their patients and research endeavors.

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“…Si se cuenta con DACO, se pueden utilizar en la FA no valvular del posoperatorio . La FA que ocurre en el contexto de bioprótesis aórtica también podría beneficiarse de DACO (18,19) , aunque se espera evidencia más concluyente al respecto. Para pacientes con bioprótesis mitral, la recomendación está aún a favor de la warfarina por los primeros 3 meses.…”

Section: Fibrilación Auricular Posoperatoriaunclassified

“…Este estudio destaca factores de riesgo potentes para el desarrollo de ETEV: historia de enfermedad arterial periférica de miembros inferiores, ACV previo, paraplejia, tratamiento quimioterapéutico actual, sepsis perioperatoria, cirugía de emergencia, tiempos quirúrgicos prolongados y estadía prolongada en cama, coincidentes con varios de los factores de riesgo que describe Caprini en su score (19) . Consideramos muy útil este score para promover el uso de tromboprofilaxis en el POCC.…”

Section: Prevención De La Enfermedad Tromboembólica Venosaunclassified

Manejo perioperatorio de la anticoagulación en cirugía cardíaca: ¿un lugar para los anticoagulantes directos?

2020

Rev Urug Cardiol.

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Clinical Benefit of Direct Oral Anticoagulants Versus Vitamin K Antagonists in Patients with Atrial Fibrillation and Bioprosthetic Heart Valves

Cited by 45 publications

References 25 publications

Atrial Fibrillation and Mitral Regurgitation: Clinical Performance of Direct Oral Anticoagulants in a Real-World Setting

Atrial Fibrillation and Mitral Regurgitation: Clinical Performance of Direct Oral Anticoagulants in a Real-World Setting

Anticoagulation and antiplatelet therapy in patients with prosthetic heart valves

Manejo perioperatorio de la anticoagulación en cirugía cardíaca: ¿un lugar para los anticoagulantes directos?

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