Non-Vitamin K Antagonists Versus Warfarin in Patients with Atrial Fibrillation and Bioprosthetic Valves: A Systematic Review and Meta-Analysis |
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| Affiliation: | 1. Heart and Vascular Center, Brigham and Women''s Hospital, Harvard Medical School, Boston, Mass;2. Department of Medicine, Federal University of Santa Catarina, Florianópolis, Brazil;3. Cardiac Arrhythmia Service, Hospital SOS Cardio, Florianópolis, Brazil;4. Division of Medicine, University of Miami, Miami, Fla;5. Division of Medicine, Federal University of Goias, Brazil;6. Harvard-Thorndike Electrophysiology Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass;7. Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC;1. Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York;2. Cardiology Section, Department of Medicine, Veterans Affairs New York Harbor Health Care System, New York, NY;3. Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio;4. Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minn;5. Department of Surgery, New York University School of Medicine, New York;1. Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill;2. Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill;3. Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill;4. Division of Epidemiology and Community Health, University of Minnesota, Minneapolis;5. Lung Health Center, University of Alabama, Birmingham, Birmingham;6. Division of Pulmonary and Critical Care, Brigham & Women''s Hospital, Boston, Mass;1. Department of Internal Medicine, Chiba Central Medical Center, Chiba-city, Chiba, Japan;2. Department of Urology, Chiba Central Medical Center, Chiba-city, Chiba, Japan;3. Department of Artificial Dialysis, Chiba Central Medical Center, Chiba-city, Chiba, Japan;1. Department of General Internal Medicine, Mitoyo General Hospital, Kanonji, Kagawa, Japan;2. Department of Ophthalmology, Mitoyo General Hospital, Kanonji, Kagawa, Japan |
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| Abstract: | BackgroundPatients with atrial fibrillation and bioprosthetic valves are at high risk for thromboembolic events. The pooled efficacy and safety of non-vitamin K oral anticoagulants (NOACs), as a class, relative to warfarin in this population is not well-known. We aimed to compare the efficacy and safety of NOACs relative to warfarin in patients with bioprosthetic valves or valve repair.MethodsWe systematically searched EMBASE, PubMed, and Cochrane databases for randomized controlled trials comparing NOACs to warfarin in patients with atrial fibrillation and bioprosthetic valves or valve repair. We pooled outcomes for stroke or systemic embolism, ischemic stroke, hemorrhagic stroke, and major bleeding.ResultsWe included 4 trials with 1379 patients, of whom 723 (52.4%) received a NOAC. Mean follow-up ranged from 90 days to 2.8 years. In the pooled analysis, stroke or systemic embolism was significantly lower in patients treated with NOACs (1.9%) compared with warfarin (3.7%) (odds ratio [OR] 0.43; 95% confidence interval [CI] 0.22-0.85; P = .02). Ischemic stroke (OR 0.72; 95% CI 0.18-2.93), hemorrhagic stroke (OR 0.18; 95% CI 0.03-1.05), cardiovascular death (OR 0.78; 95% CI 0.38-1.62), and all-cause mortality (OR 0.94; 95% CI 0.55-1.62) were not significantly different among groups. Major bleeding was significantly lower in patients treated with NOAC (2.8%) compared with warfarin (4.7%) (OR 0.49; 95% CI 0.28-0.88; P = .02).ConclusionsIn patients with atrial fibrillation and bioprosthetic valves or valve repair, NOACs are associated with a reduced incidence of thromboembolic events and major bleeding as compared with warfarin. Thus, NOACs may be considered a preferred option for this patient population. |
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