NOAC versus warfarin in the treatment of atrial fibrillation during the first three months after bioprosthetic aortic valve replacement

Abstract

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Optimal anticoagulation in patients with atrial fibrillation and bioprosthetic heart valves

“…Tables 5 and 6 show the characteristics and results of the studies. The preliminary results of the observational studies were confirmed in several RCTs [11][12][13].…”

“…In a recent small trial [12], 50 AF patients undergoing aortic BHV replacement were randomized to receive apixaban (n = 25 patients) or warfarin (n = 25 patients) in a 1:1 ratio for the first 3 months after surgery. At 3 months follow-up, no valvular dysfunction was recorded; major bleeding events occurred in 3 patients (12%) among the warfarin group and none in the apixaban group.…”

“…The antithrombotic management of patients after bioprosthetic heart valves (BHVs), both surgical and transcatheter, is still challenging. Among patients in need of long-term oral anticoagulation therapy (OAC), such as those with AF, there is little evidence from randomized control trials (RCTs) about the best treatment between NOACs or VKAs in those with BHVs [11][12][13] or transcatheter aortic valve implantation (TAVI) [14,15]. Currently, both the European Society of Cardiology/European Association for Cardio-Thoracic Surgery (ESC/EACTS) and American College of Cardi-ology/American Heart Association (ACC/AHA) guidelines apply few class-I recommen dations or level of evidence A to OAC therapy among patients with BHVs [4,5].…”

A parametric study regarding structural design of a bioprosthetic aortic valve by 3D fluid-structure interaction simulations

“…However, the use of bioprosthetic valves has been steadily increasing, even in relatively young patients, considering the benefits of avoiding lifelong anticoagulation therapy and subsequent lifestyle modifications. Because the age of patients using bioprostheses is decreasing and patients tend to live longer, the durability of the bioprosthetic valve has become a significant goal to achieve [ 35 ].…”

Evaluating the Efficacy of New Oral Anticoagulant Therapies in Preventing Events Related to Atrial Fibrillation: A Literature Review

“…Portanto, a segurança e tolerabilidade das novas terapias anticoagulantes orais são aspectos críticos a serem considerados na prática clínica. Embora ofereçam benefícios significativos em termos de redução do risco de sangramento intracraniano e gastrointestinal, é essencial uma abordagem cuidadosa, com monitorização regular da função renal e hepática, e estratégias de reversão disponíveis para garantir a segurança e eficácia desses agentes na prevenção de eventos cardiovasculares em pacientes com fibrilação atrial (Piepiorka-Broniecka et al, 2022).…”