Comparison of Direct Oral Anticoagulants and Warfarin in the Prevention of Stroke in Patients With Valvular Heart Disease: A Meta-Analysis

Batool, Saima; Chaudhari, Sandipkumar S; Shaik, Tanveer Ahamad; Dhakal, Sandesh; Ganaie, Zubair Ahmad; Ghaffari, Muhammad Abu Zar; Saleem, Faraz; Khan, Areeba

doi:10.7759/cureus.28763

Cited by 3 publications

(4 citation statements)

References 25 publications

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“…To our knowledge, this marks the inaugural systematic review and network meta-analysis endeavoring to amalgamate the available advantages and drawbacks of newer oral anticoagulants for averting stroke and major bleeding occurrences in patients grappling with valvular heart disease. A recent meta-analysis by Batool et al [ 10 ], encompassing five randomized controlled trials (RCTs), concluded that DOACs exhibit greater efficacy than warfarin in preventing stroke and major bleeding events. Nonetheless, our current meta-analysis encompasses recently published RCTs as well as observational studies.…”

Section: Reviewmentioning

confidence: 99%

“…In patients with non-valvular AF, the non-inferiority of direct oral anticoagulants (DOACs) compared to warfarin has already been established [ 7 , 8 ]; hence, DOACs are widely adopted in routine clinical practice due to their avoidance of routine anticoagulation monitoring or dose adjustment [ 9 ]. DOACs have also proven effective as an alternative to warfarin in AF patients with valvular heart disease [ 10 ]. Current guidelines advocate for DOACs as the preferred initial therapy in AF patients with a bioprosthetic valve alongside warfarin [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

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Comparison of Effectiveness and Safety of Apixaban, Dabigatran, and Rivaroxaban in Patients With Valvular Atrial Fibrillation: A Network Meta-Analysis of Randomized-Control Trials and Observational Studies

Huma,

Rawat,

Kaur

et al. 2024

Cureus

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The objective of this network meta-analysis was to assess the efficacy and safety of apixaban, dabigatran, rivaroxaban, and edoxaban in patients diagnosed with atrial fibrillation and valvular heart disease. A comprehensive search was conducted across various electronic databases, including PubMed, Embase, and Web of Science, from inception to February 15, 2024. The search strategy utilized a combination of medical subject headings (MeSH) terms and relevant keywords related to valvular heart disease, atrial fibrillation, anticoagulant therapy, and study design, such as randomized controlled trials and observational studies. The outcomes evaluated in this analysis comprised the incidence of stroke or systemic embolism (SE), as well as the occurrences of major bleeding events. A total of 10 studies were incorporated into this meta-analysis, encompassing 40,662 participants. Of these, 12,385 received apixaban, 2,829 received dabigatran, 13,662 received rivaroxaban, 2,582 received edoxaban, and 9,202 received warfarin. The duration of follow-up in the included studies ranged from 3 to 54 months. Among the four direct oral anticoagulants (DOACs) studied, apixaban demonstrated a significant reduction in the risk of stroke or SE when compared to other DOACs and warfarin, highlighting its efficacy in patients with atrial fibrillation and valvular heart disease. Additionally, apixaban exhibited a lower risk of major bleeding events, further emphasizing its favorable safety profile compared to the other agents assessed. In conclusion, our findings suggest that apixaban may be more effective and safer than other DOACs and warfarin in this patient population. However, additional studies are warranted to compare the various DOACs in this cohort to identify the optimal treatment strategy for preventing adverse outcomes.

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Section: Reviewmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Comparison of Effectiveness and Safety of Apixaban, Dabigatran, and Rivaroxaban in Patients With Valvular Atrial Fibrillation: A Network Meta-Analysis of Randomized-Control Trials and Observational Studies

Huma,

Rawat,

Kaur

et al. 2024

Cureus

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“…And, the risk of bleeding and all-cause mortality associated with warfarin is significantly higher than with other nonvitamin K-dependent direct oral anticoagulants (DOACs). 4 – 6 …”

Section: Introductionmentioning

confidence: 99%

A Novel Nomogram for Predicting Warfarin-Related Bleeding: A Retrospective Cohort Study

Yang,

Yao

2024

Clin Appl Thromb Hemost

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Warfarin is a widely used anticoagulant, and bleeding complications are the main reason why patients discontinue the drug. Currently, there is no nomogram model for warfarin-associated bleeding risk. The aim of this study was to develop a risk-prediction nomogram model for warfarin-related major and clinically relevant non-major (CRNM) bleeding. A total of 280 heart disease outpatients taking warfarin were enrolled, 42 of whom experienced major or CRNM bleeding at the one-year follow-up. The Least Absolute Shrinkage and Selection Operator regression model was employed to identify potential predictors. Backward stepwise selection with the Akaike information criterion was used to establish the optimal predictive nomogram model. The receiver operating characteristic (ROC) curve, calibration plot, Hosmer–Lemeshow goodness-of-fit test, and decision curve analysis (DCA) were used to evaluate the performance of the nomogram. The nomogram consisted of four predictors: female (OR = 1.85; 95% CI: 0.91-3.94), TIA (OR = 6.47; 95% CI: 1.85-22.7), TTR (OR = 0.99; 95% CI: 0.97-1.00), and anemia (OR = 2.30; 95% CI: 1.06-4.84). The model had acceptable discrimination (area under the ROC curve = 0.68, 95% CI: 0.59-0.78), and was significantly better than the existing nine warfarin-related bleeding prediction scoring systems. The calibration plot and Hosmer–Lemeshow test (χ² = 7.557; P = .478) indicated well-calibrated data in the model. The DCA demonstrated good clinical utility. In this study, we developed a nomogram to predict the risk of warfarin-related major or CRNM bleeding. The model has good performance, allows rapid risk stratification of warfarin users, and provides a basis for personalized treatment.

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“…Direct oral anticoagulants (DOACs) offer an alternative option for individuals with atrial fibrillation and have increasingly supplanted VKAs in clinical practice. For the majority of adults with atrial fibrillation, DOACs provide a significant net clinical benefit in preventing major thromboembolic events [ 8 , 9 ]. They are favored for their broader therapeutic window and ease of use, owing to fixed oral dosing and reduced need for regular laboratory monitoring or dose adjustments compared to VKAs [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of Direct Oral Anticoagulants and Vitamin K Antagonists in Preventing Stroke in Patients With Atrial Fibrillation and Liver Cirrhosis: A Systematic Review and Meta-Analysis

Sinha,

Kaur,

Mayow

et al. 2024

Cureus

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Patients with atrial fibrillation and concurrent liver cirrhosis have been excluded from major clinical trials evaluating direct oral anticoagulants (DOACs) due to safety concerns. This has led to uncertainty regarding the optimal anticoagulant therapy in this population at high risk of thromboembolic events. We conducted a systematic review and meta-analysis to compare the effectiveness and safety of DOACs versus vitamin K antagonists (VKAs) in patients with atrial fibrillation and liver cirrhosis. Databases including Embase, MEDLINE/PubMed, and Web of Science were searched for relevant studies. The primary effectiveness outcome was stroke or systemic embolism, and the safety outcome was major bleeding events. A total of 10 studies were included in the meta-analysis. Compared to VKAs, the use of DOACs was associated with a significantly lower risk of stroke or systemic embolism (RR: 0.78, 95% CI: 0.65-0.92, p=0.005). The risk of all-cause mortality was comparable between the two groups (RR: 0.89, 95% CI: 0.74-1.07, p=0.23). Notably, DOACs demonstrated a significantly lower risk of major bleeding events (RR: 0.67, 95% CI: 0.61-0.73, p<0.01) compared to VKAs. This meta-analysis suggests that DOACs may be a favorable alternative to VKAs for the prevention of thromboembolic events in patients with atrial fibrillation and liver cirrhosis, with a lower risk of stroke or systemic embolism and major bleeding. However, further research is needed to establish optimal dosing strategies and assess the safety and efficacy of DOACs in patients with advanced liver disease.

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Comparison of Direct Oral Anticoagulants and Warfarin in the Prevention of Stroke in Patients With Valvular Heart Disease: A Meta-Analysis

Cited by 3 publications

References 25 publications

Comparison of Effectiveness and Safety of Apixaban, Dabigatran, and Rivaroxaban in Patients With Valvular Atrial Fibrillation: A Network Meta-Analysis of Randomized-Control Trials and Observational Studies

Comparison of Effectiveness and Safety of Apixaban, Dabigatran, and Rivaroxaban in Patients With Valvular Atrial Fibrillation: A Network Meta-Analysis of Randomized-Control Trials and Observational Studies

A Novel Nomogram for Predicting Warfarin-Related Bleeding: A Retrospective Cohort Study

Effectiveness of Direct Oral Anticoagulants and Vitamin K Antagonists in Preventing Stroke in Patients With Atrial Fibrillation and Liver Cirrhosis: A Systematic Review and Meta-Analysis

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