Off-label Use of Direct Oral Anticoagulants in Patients Receiving Surgical Mechanical and Bioprosthetic Heart Valves

Kalra, Ankur; Raza, Sajjad; Jafry, Baqir Hasan; King, Harley E.; Lahorra, Joseph A.; Svensson, Lars G.; Kapadia, Samir

doi:10.1001/jamanetworkopen.2021.1259

Cited by 12 publications

(4 citation statements)

References 3 publications

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“…We identified 15,457 people with a code for ever receiving a mechanical heart valve suggesting that not all mechanical valve replacements are explicitly coded in GP records. A US study showed an overall 1% rate of postoperative DOAC prescribing following surgical aortic or mitral valve replacement with mechanical valves between 2014 and 2017, in 18,000 people with comparable sex and age distributions to our study 8 . This is lower than the 6.8% rate observed in this study.…”

Section: Findings In Contextsupporting

confidence: 67%

Potentially inappropriate prescribing of DOACs to people with mechanical heart valves: a federated analysis of 57.9 million patients’ primary care records in situ using OpenSAFELY

Fisher

Speed

Curtis

et al. 2021

Preprint

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National guidance was issued during the COVID-19 pandemic to switch patients on warfarin to direct oral anticoagulants (DOACs) where appropriate as these require less frequent blood testing. DOACs are not recommended for patients with mechanical heart valves. We conducted a retrospective cohort study of DOAC prescribing in people with a record of a mechanical heart valve between September 2019 and May 2021, and describe the characteristics of this population. We identified 15,457 individuals with a mechanical heart valve recorded in their records, of whom 1058 (6.8%) had been prescribed a DOAC during the study period. 767 individuals with a record of a mechanical heart valve were currently prescribed a DOAC as of May 31st 2020. This is suggestive of inappropriate prescribing of DOACs in individuals with mechanical heart valves. Direct alerts have been issued to clinicians through their EHR software informing the issue. We show that the OpenSAFELY platform can be used for rapid audit and feedback to mitigate the indirect health impacts of COVID-19 on the NHS. We will monitor changes in prescribing for this risk group over the following months.

show abstract

Section: Findings In Contextsupporting

confidence: 67%

Potentially inappropriate prescribing of DOACs to people with mechanical heart valves: a federated analysis of 57.9 million patients’ primary care records in situ using OpenSAFELY

Fisher

Speed

Curtis

et al. 2021

Preprint

View full text Add to dashboard Cite

show abstract

“…We identified 15,457 people with a code for ever receiving a mechanical heart valve suggesting that not all mechanical valve replacements are explicitly coded in GP records. A US study showed an overall 1% rate of postoperative DOAC prescribing following surgical aortic or mitral valve replacement with mechanical valves between 2014 and 2017, in 18,000 people with comparable sex and age distributions to our study (5). This is lower than the 6.8% rate observed in this study.…”

Section: Findings In Contextcontrasting

confidence: 64%

Potentially inappropriate prescribing of DOACs to people with mechanical heart valves: A federated analysis of 57.9 million patients' primary care records in situ using OpenSAFELY

Fisher

Speed

Curtis

et al. 2022

Thrombosis Research

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“…Furthermore, another registry study was conducted using data from 2014 to 2017 of 177 915 patients after a surgically placed mechanical or bioprosthetic valve. 50 Of patients discharged on a DOAC (type unspecified), 5% had a bioprosthetic valve and 1% had a mechanical valve. There is an increasing usage of DOACs in mechanical valves, even though there is a direct contraindication (dabigatran) or strong precaution against use (rivaroxaban, apixaban, edoxaban) in this population.…”

Section: Discussionmentioning

confidence: 99%

DOACs in Mechanical and Bioprosthetic Heart Valves: A Narrative Review of Emerging Data and Future Directions

Ryu

Tran

2022

Clin Appl Thromb Hemost

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In the recent years, there has been significant transformation in the management of valvular heart disease (VHD), as a result of new minimally invasive technologies, such as the transcatheter aortic valve implantation (TAVI). Conventionally, mechanical heart valves require anticoagulation with warfarin to prevent thrombogenic events. Lately, there has been an uptrend in the usage of direct-acting oral anticoagulants (DOACs) in both mechanical and bioprosthetic heart valves. In clinical practice, there has shown to be notable heterogeneity in the antithrombotic regimen for patients. Recommendations from clinical guidelines and emerging data on DOAC use in these settings will be critically reviewed here. Future large, randomized-controlled trials are warranted to delineate the role of DOACs in patients receiving a bioprosthetic valve/TAVI or mechanical heart valve, with and without a baseline indication for anticoagulation or antiplatelets. Until clinical trial data from well-designed studies are available, providers must remain vigilant about DOAC use in patients with VHD, especially in patients with a bioprosthetic or mechanical heart valve.

show abstract

Off-label Use of Direct Oral Anticoagulants in Patients Receiving Surgical Mechanical and Bioprosthetic Heart Valves

Abstract: This cohort study assesses direct oral anticoagulant use in patients with surgical prosthetic heart valves in the United States and evaluates differences in preoperative and postoperative profiles in patients discharged while receiving direct oral anticoagulant vs warfarin.

Cited by 12 publications

References 3 publications

Potentially inappropriate prescribing of DOACs to people with mechanical heart valves: a federated analysis of 57.9 million patients’ primary care records in situ using OpenSAFELY

Potentially inappropriate prescribing of DOACs to people with mechanical heart valves: a federated analysis of 57.9 million patients’ primary care records in situ using OpenSAFELY

Potentially inappropriate prescribing of DOACs to people with mechanical heart valves: A federated analysis of 57.9 million patients' primary care records in situ using OpenSAFELY

DOACs in Mechanical and Bioprosthetic Heart Valves: A Narrative Review of Emerging Data and Future Directions

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