NOACs comparable to warfarin when treating AFib patients with valvular heart disease

Non-vitamin K antagonist oral anticoagulants (NOACs) may be a safe alternative to warfarin when treating patients with atrial fibrillation (AFib) and valvular heart disease (VHD), according to new research published in the American Journal of Cardiology.[1]

“NOACs have replaced a large portion of warfarin use given their better efficacy and safety profiles, proved in multiple randomized controlled trials,” wrote lead author Min Soo Cho, MD, a specialist with ASAN Medical Center in Korea, and colleagues. “However, the role of NOACs in managing valvular AFib remains undetermined, particularly in AFib associated with mitral stenosis (MS). Dabigatran etexilate is a NOAC used to treat nonvalvular AFib; evidence on the efficacy and safety of dabigatran in AFib patients with native VHD is lacking.”

The group examined data from 59 valvular AFib patients given dabigatran and 60 valvular AFib patients given warfarin. All patients were enrolled at a single facility from March 2017 to October 2019. The mean patient age was 61.2 years old, 69% of patients were male and the mean CHA2DS2-VASc score was 2.1.

A significant number of patients (87%) were already taking warfarin prior to being enrolled in this analysis. When the study began, any patients already taking warfarin who were randomized to the dabigatran group stopped taking the warfarin.

Overall, the authors wrote, no strokes or deaths were seen in either patient group. The study’s primary endpoint, stroke or silent brain lesion, was seen in 34% of patients in the dabigatran group and 40% of patients in the conventional treatment/warfarin group. Follow-up MRI results confirmed that there was no difference in the number of new silent brain infarct lesions between the two groups. While clinical bleeding events were less likely among dabigatran patients, the difference was not large enough to be viewed as significant.