Direct Oral Anticoagulants Compared With Warfarin in Patients With Atrial Fibrillation and Valvular Heart Disease Without Mechanical Valves
Background Despite proven efficacy and safety of direct oral anticoagulants (DOACs) over warfarin in patients with atrial fibrillation (AF), data on patients with AF and valvular heart disease remain scarce. We aimed to evaluate the DOACs compared with warfarin among patients with AF and valvular he...
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Wiley
2025-02-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
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| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.124.035478 |
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| author | Ghadeer K. Dawwas James D. Lewis Adam Cuker |
| author_facet | Ghadeer K. Dawwas James D. Lewis Adam Cuker |
| author_sort | Ghadeer K. Dawwas |
| collection | DOAJ |
| description | Background Despite proven efficacy and safety of direct oral anticoagulants (DOACs) over warfarin in patients with atrial fibrillation (AF), data on patients with AF and valvular heart disease remain scarce. We aimed to evaluate the DOACs compared with warfarin among patients with AF and valvular heart disease. Methods and Results We conducted a retrospective cohort study of patients ≥18 years of age, who had AF and valvular heart disease, and were new users of DOACs or warfarin. The primary effectiveness outcomes were ischemic stroke or systemic embolism, and bleeding for safety. We used Cox proportional‐hazards regression after propensity score matching to estimate hazard ratios (HRs) and 95% CIs. In the matched cohort, DOAC use (versus warfarin) was associated with a lower rate of ischemic stroke or systemic embolism (HR, 0.70 [95% CI, 0.61–0.81]) and bleeding (HR, 0.72 [95% CI, 0.65–0.80]). We found a lower rate of ischemic stroke or systemic embolism with rivaroxaban (HR, 0.74 [95% CI, 0.62–0.89]) and apixaban (HR, 0.62 [95% CI, 0.52–0.74]) but not dabigatran (HR, 0.89 [95% CI, 0.63–1.26]). We found a lower rate of bleeding with rivaroxaban (HR, 0.84 [95% CI, 0.74–0.95]), apixaban (HR, 0.60 [95% CI, 0.53–0.68]), dabigatran (HR, 0.75 [95% CI, 0.58–0.97]), and edoxaban (HR, 0.21 [95% CI, 0.05–0.83]). We were unable to obtain estimates for the effectiveness outcome with edoxaban due to the small number of events. Conclusions In this study of patients with AF and valvular heart disease, DOAC treatment was associated with a lower risk of ischemic stroke or systemic embolism and bleeding compared with warfarin. |
| format | Article |
| id | doaj-art-dfdf5090e6f14733bd88eee0602d6418 |
| institution | DOAJ |
| issn | 2047-9980 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj-art-dfdf5090e6f14733bd88eee0602d64182025-08-20T03:17:27ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802025-02-0114410.1161/JAHA.124.035478Direct Oral Anticoagulants Compared With Warfarin in Patients With Atrial Fibrillation and Valvular Heart Disease Without Mechanical ValvesGhadeer K. Dawwas0James D. Lewis1Adam Cuker2Department of Medicine, Division of Epidemiology Vanderbilt University School of Medicine Nashville TNCenter for Clinical Epidemiology and Biostatistics, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine University of Pennsylvania Philadelphia PADepartment of Medicine and Department of Pathology & Laboratory Medicine, Perelman School of Medicine University of Pennsylvania Philadelphia PABackground Despite proven efficacy and safety of direct oral anticoagulants (DOACs) over warfarin in patients with atrial fibrillation (AF), data on patients with AF and valvular heart disease remain scarce. We aimed to evaluate the DOACs compared with warfarin among patients with AF and valvular heart disease. Methods and Results We conducted a retrospective cohort study of patients ≥18 years of age, who had AF and valvular heart disease, and were new users of DOACs or warfarin. The primary effectiveness outcomes were ischemic stroke or systemic embolism, and bleeding for safety. We used Cox proportional‐hazards regression after propensity score matching to estimate hazard ratios (HRs) and 95% CIs. In the matched cohort, DOAC use (versus warfarin) was associated with a lower rate of ischemic stroke or systemic embolism (HR, 0.70 [95% CI, 0.61–0.81]) and bleeding (HR, 0.72 [95% CI, 0.65–0.80]). We found a lower rate of ischemic stroke or systemic embolism with rivaroxaban (HR, 0.74 [95% CI, 0.62–0.89]) and apixaban (HR, 0.62 [95% CI, 0.52–0.74]) but not dabigatran (HR, 0.89 [95% CI, 0.63–1.26]). We found a lower rate of bleeding with rivaroxaban (HR, 0.84 [95% CI, 0.74–0.95]), apixaban (HR, 0.60 [95% CI, 0.53–0.68]), dabigatran (HR, 0.75 [95% CI, 0.58–0.97]), and edoxaban (HR, 0.21 [95% CI, 0.05–0.83]). We were unable to obtain estimates for the effectiveness outcome with edoxaban due to the small number of events. Conclusions In this study of patients with AF and valvular heart disease, DOAC treatment was associated with a lower risk of ischemic stroke or systemic embolism and bleeding compared with warfarin.https://www.ahajournals.org/doi/10.1161/JAHA.124.035478anticoagulantsatrial fibrillationeffectivenesssafetyvalvular heart disease |
| spellingShingle | Ghadeer K. Dawwas James D. Lewis Adam Cuker Direct Oral Anticoagulants Compared With Warfarin in Patients With Atrial Fibrillation and Valvular Heart Disease Without Mechanical Valves Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease anticoagulants atrial fibrillation effectiveness safety valvular heart disease |
| title | Direct Oral Anticoagulants Compared With Warfarin in Patients With Atrial Fibrillation and Valvular Heart Disease Without Mechanical Valves |
| title_full | Direct Oral Anticoagulants Compared With Warfarin in Patients With Atrial Fibrillation and Valvular Heart Disease Without Mechanical Valves |
| title_fullStr | Direct Oral Anticoagulants Compared With Warfarin in Patients With Atrial Fibrillation and Valvular Heart Disease Without Mechanical Valves |
| title_full_unstemmed | Direct Oral Anticoagulants Compared With Warfarin in Patients With Atrial Fibrillation and Valvular Heart Disease Without Mechanical Valves |
| title_short | Direct Oral Anticoagulants Compared With Warfarin in Patients With Atrial Fibrillation and Valvular Heart Disease Without Mechanical Valves |
| title_sort | direct oral anticoagulants compared with warfarin in patients with atrial fibrillation and valvular heart disease without mechanical valves |
| topic | anticoagulants atrial fibrillation effectiveness safety valvular heart disease |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.124.035478 |
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