Comparison of the Efficacy and Safety of Direct Oral Anticoagulants and Warfarin After Bioprosthetic Valve Replacements

Pasciolla, Stacy; Zizza, Laura; Le, Thuy T.; Wright, Kesha

doi:10.1007/s40261-020-00939-x

Cited by 24 publications

(17 citation statements)

References 12 publications

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“…Nevertheless, the results are promising for the safety and efficacy of DOAC therapy in bioprosthetic valve replacements 39 . Aside from RIVER, a small retrospective study has suggested that DOACs may be safe in place of warfarin for aortic or mitral bioprosthetic valve replacement in this acute postoperative phase 40 …”

Section: Resultsmentioning

confidence: 99%

“…39 Aside from RIVER, a small retrospective study has suggested that DOACs may be safe in place of warfarin for aortic or mitral bioprosthetic valve replacement in this acute postoperative phase. 40 For patients with transcatheter aortic valve replacement (TAVR), dual antiplatelet therapy with aspirin and clopidogrel for 6 months followed by lifelong aspirin is recommended. One post hoc analysis of TAVR patients found that three months of anticoagulation with warfarin was associated with significantly less thrombosis than with 3 months of DAPT, and is therefore considered reasonable in patients at low risk of bleeding.…”

Section: Prosthetic Valvementioning

confidence: 99%

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A review of indications and comorbidities in which warfarin may be the preferred oral anticoagulant

et al. 2021

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What is known and objective: Direct oral anticoagulants (DOACs) are increasingly prescribed instead of warfarin for chronic anticoagulation for ease of dosing, fewer interactions, and less stringent monitoring. However, it is important to consider indications and comorbidities for which warfarin is still the preferred anticoagulant. This review aims to capture these clinical scenarios in which warfarin may still be preferred over DOACs. Methods: We undertook a comprehensive literature search using the PubMed database. Key search terms were based on DOAC clinical trial exclusion criteria, as well as indications and conditions in which the use of DOACs for anticoagulation has suggested harm. Society guidelines and tertiary literature were used to inform expert opinion where necessary. Studies were included if they investigated the use of DOACs or warfarin in the identified indications or conditions. Results and Discussion: Currently, evidence for the use of warfarin over DOACs for anticoagulation is strongest for patients with prosthetic valves, antiphospholipid syndrome, or a high risk of gastrointestinal bleeding. For several clinical situations, including mitral stenosis, obesity, altered gastrointestinal anatomy, pulmonary arterial hypertension, renal or hepatic impairment, and left ventricular thrombus, evidence is lacking but may eventually support the use of DOACs. Depending on indication and condition, appropriateness of DOAC use may vary by agent.What is new and conclusion: New evidence continues to support new indications and conditions in which DOACs may be appropriate to use for anticoagulation. There are key clinical scenarios, however, in which emerging literature continues to support warfarin as the preferred anticoagulant.

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Section: Resultsmentioning

confidence: 99%

Section: Prosthetic Valvementioning

confidence: 99%

A review of indications and comorbidities in which warfarin may be the preferred oral anticoagulant

et al. 2021

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“…Pasciolla et al evaluated the use of DOACs compared with warfarin following bioprosthetic aortic and mitral valve replacement. 15 A total of 86 patients received apixaban, 40 received rivaroxaban, and 1 received dabigatran. Clinical event rates were similar between warfarin and DOACs during the 6-month follow-up period, which was longer than the 3 months assessed in our study.…”

Section: Discussionmentioning

confidence: 99%

Safety and Efficacy of Apixaban Following Bioprosthetic Valve Replacements: A Retrospective Evaluation

Ball

Covington

2021

Journal of Pharmacy Technology

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Background: Data on the use of direct oral anticoagulants in the setting of bioprosthetic valve replacements is limited. Objective: The purpose of this study was to describe outcomes among patients who underwent a bioprosthetic valve replacement and were subsequently prescribed apixaban. Methods: A retrospective cohort study was completed for inpatients at a community hospital who were prescribed apixaban following a bioprosthetic valve replacement from 2015 to 2020. Endpoints assessed included incidence of all-cause readmission and emergency visits within 3 months following valvular surgery, incidence of mortality, and all-cause major and minor bleeding. A post hoc analysis was conducted comparing outcomes among patients who underwent mitral versus aortic valve replacement, as well as patients with and without atrial fibrillation. The study was deemed exempt by hospital and university institutional review boards. Results: A total of 54 patients were included for analysis. All-cause readmission or emergency visit occurred in 33% (n = 18) of patients and the mortality rate was 6% (n = 3). A minor bleeding event was reported in 6% (n = 3) of patients and a major bleeding event was reported in 2% (n = 1) of patients. A thrombotic event was reported in 2% (n = 1) of patients. Conclusion: Within this cohort of patients requiring anticoagulation following bioprosthetic valve replacement, apixaban was safe and well-tolerated. However, more prospective data are needed to further correlate the safety and efficacy of apixaban, particularly in the setting of mitral valve replacement.

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“…The small amount of data that does not focus on AF comes from a retrospective study where no significant differences were found between patients taking DOACs and those taking warfarin in the incidence of major bleeding, thromboembolic events, or in 6-month readmission rates. 62 It is worth noting that the study design leads to an inherent bias in patient selection as the choice of the patient treatment group was determined on a case-by-case basis without randomization. This could mean that factors that may have influenced the consultant's choice of therapy could also correlate to patient outcomes.…”

Section: Direct Oral Anticoagulantsmentioning

confidence: 99%

“…The majority of research thus far, comparing its use to that of VKAs, is centered around patients with concurrent AF. The small amount of data that does not focus on AF comes from a retrospective study where no significant differences were found between patients taking DOACs and those taking warfarin in the incidence of major bleeding, thromboembolic events, or in 6‐month readmission rates 62 . It is worth noting that the study design leads to an inherent bias in patient selection as the choice of the patient treatment group was determined on a case‐by‐case basis without randomization.…”

Section: Antithrombotic Therapy In Bioprosthetic Valve Replacementmentioning

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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Comparison of the Efficacy and Safety of Direct Oral Anticoagulants and Warfarin After Bioprosthetic Valve Replacements

Cited by 24 publications

References 12 publications

A review of indications and comorbidities in which warfarin may be the preferred oral anticoagulant

A review of indications and comorbidities in which warfarin may be the preferred oral anticoagulant

Safety and Efficacy of Apixaban Following Bioprosthetic Valve Replacements: A Retrospective Evaluation

Anticoagulation and antiplatelet therapy in patients with prosthetic heart valves

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