Valvular & structural heart disease
Direct Oral Anticoagulants for Rheumatic Heart Disease-Associated Atrial Fibrillation Post-Bioprosthetic Mitral Valve Replacement
Authors' conclusion
Among patients with RHD-associated AF patients post-bioprosthetic MVR, DOACs are associated with lower major bleeding and comparable effectiveness, indicating a potential alternative to warfarin.
Study context
- Population
- Patients with rheumatic heart disease (RHD)-associated atrial fibrillation (AF) after bioprosthetic mitral valve replacement (MVR)matched cohort n = 1,832
- Participants
- 3,950 patients
- Exposure
- Direct oral anticoagulants (DOACs) vs warfarin
- DOACn = 916
- Warfarinn = 916reference
- Outcome
- Ischemic events (effectiveness) and major bleeding (safety)
- Follow-up
- 5-year follow-up
Methodological detailspropensity-score matched
- Propensity-score matched
Main finding
As reported in the abstract
Ischemic events
- No significant difference in ischemic events, DOAC vs warfarin
- Matched cohort (n = 1,832)
Observational data: associations, not effects.
Secondary outcomes
All-cause mortality, cardiac thrombosis, MI, all-cause hospitalization · 5-year follow-up
- No significant difference in mortality, cardiac thrombosis, MI or hospitalization
Safety
| Outcome | HR (95% CI) | |
|---|---|---|
| Major bleeding · 5-year follow-up | 0.76 (0.62–0.94) | |
| 0.512Hazard ratio (log scale) |
- Major bleeding: matched cohort (n = 1,832)
Original publication
Direct Oral Anticoagulants for Rheumatic Heart Disease-Associated Atrial Fibrillation Post-Bioprosthetic Mitral Valve Replacement. JACC Clin Electrophysiol. Published 2 October 2024. doi:10.
Summarised from the published abstract; every number is checked against it