Comparison of Direct Oral Anticoagulants and Warfarin in Patients With Atrial Fibrillation and an Aortic Bioprosthetic Valve.

Abstract

BACKGROUND:

Current guidelines equally recommend direct oral anticoagulants (DOACs) and warfarin for atrial fibrillation (AF) patients with a bioprosthetic valve (BPV); however, there are limited data comparing DOACs and warfarin in AF patients with an aortic BPV.Methods and Results: This post-hoc subgroup analysis of a multicenter, prospective, observational registry (BPV-AF Registry) aimed to compare DOACs and warfarin in AF patients with an aortic BPV. The primary outcome was a composite of stroke, systemic embolism, major bleeding, heart failure requiring hospitalization, all-cause death, or BPV reoperation. The analysis included 479 patients (warfarin group, n=258; DOAC group, n=221). Surgical aortic valve replacement was performed in 74.4% and 36.7% of patients in the warfarin and DOAC groups, respectively. During a mean follow up of 15.5 months, the primary outcome occurred in 45 (17.4%) and 32 (14.5%) patients in the warfarin and DOAC groups, respectively. No significant difference was found in the primary outcome between the 2 groups (adjusted hazard ratio: 0.88, 95% confidence interval: 0.51-1.50). No significant multiplicative interaction was observed between the anticoagulant effects and type of aortic valve procedure (P=0.577).

CONCLUSIONS:

Among AF patients with an aortic BPV, no significant difference was observed in the composite outcome of adverse clinical events between patients treated with warfarin and those treated with DOACs, suggesting that DOACs can be used as alternatives to warfarin in these patients.

• Authors: Makoto Miyake, Misa Takegami, Yuki Obayashi, Masashi Amano, Takeshi Kitai, Tomoyuki Fujita, Tadaaki Koyama, Hidekazu Tanaka, Kenji Ando, Tatsuhiko Komiya, Masaki Izumo, Hiroya Kawai, Kiyoyuki Eishi, Kiyoshi Yoshida, Takeshi Kimura, Ryuzo Nawada, Tomohiro Sakamoto, Yoshisato Shibata, Toshihiro Fukui, Kenji Minatoya, Kenichi Tsujita, Yasushi Sakata, Tetsuya Kimura, Kumiko Sugio, Atsushi Takita, Atsushi Iwakura, Toshihiro Tamura, Kunihiro Nishimura, Yutaka Furukawa, Chisato Izumi, BPV-AF Registry Group
• Journal: Circulation journal : official journal of the Japanese Circulation Society (Circ J) Vol. 86 Issue 11 Pg. 1699-1707 (10 25 2022) ISSN: 1347-4820 [Electronic] Japan
• PMID: 35811134 (Publication Type: Observational Study, Multicenter Study, Journal Article)

Chemical References

• Warfarin
• Anticoagulants

Topics

• Humans
• Warfarin (adverse effects)
• Atrial Fibrillation (drug therapy, complications)
• Aortic Valve (surgery)
• Prospective Studies
• Administration, Oral
• Anticoagulants (adverse effects)
• Stroke (prevention & control, chemically induced)
• Treatment Outcome