DOACs an effective substitute for VKAs after AFib patients undergo bioprosthetic valve replacement

Direct oral anticoagulants (DOACs) may be an effective anticoagulation strategy for atrial fibrillation (AFib) patients who undergo bioprosthetic valve replacement, according to a new meta-analysis published in the American Journal of Cardiology.[1]

“Anticoagulation strategies in patients with AFib who underwent bioprosthetic valve replacement are still controversial,” wrote lead author Safia Shaikh, MD, an internal medicine specialist with SSM Health St. Mary's Hospital - St. Louis, and colleagues. “Despite dramatic increase in volume, postoperative anticoagulation continues to be a challenge.”

The group also emphasized that many recommendations for anticoagulation in this patient population have been powered by “limited evidence” from “small, underpowered” studies. A meta-analysis, they hoped, could better context that could help clinicians provide the best care possible.

Shaikh et al. examined data from three randomized controlled trials. The total cohort included nearly 2,500 patients, and 50% were treated with DOACs. The remaining patients were prescribed an anticoagulation strategy that included vitamin K antagonists (VKAs), a more traditional strategy, instead of DOACs. The mean patient age was 72.4 years old, and 53% were women. The mean follow-up period was 16 months.

Two different specialists extracted the data independently of one another. The team’s primary outcome was all-cause mortality, but secondary outcomes included such complications as stroke/systemic embolization, intracardiac thrombosis and bleeding events.