Direct oral anticoagulants in patients with atrial fibrillation and bioprosthetic valve replacement: A meta‐analysis

2021 ◽  
Author(s):  
Spencer C. Lacy ◽  
Garly R. Saint Croix ◽  
Kadijah Porter ◽  
Azeem Latib ◽  
Nirat Beohar
Keyword(s):  
Atrial Fibrillation ◽  
Valve Replacement ◽  
Meta Analysis ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Bioprosthetic Valve ◽  
Bioprosthetic Valve Replacement

Safety and Efficacy of Apixaban Following Bioprosthetic Valve Replacements: A Retrospective Evaluation

2021 ◽  
pp. 875512252110215
Author(s):  
Kellie Ball ◽  
Elizabeth W. Covington
Keyword(s):  
Valve Replacement ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Thrombotic Event ◽  
Bleeding Event ◽  
Bioprosthetic Valve ◽  
Minor Bleeding ◽  
Safety And Efficacy ◽  
Valvular Surgery ◽  
Bioprosthetic Valve Replacement

Background: Data on the use of direct oral anticoagulants in the setting of bioprosthetic valve replacements is limited. Objective: The purpose of this study was to describe outcomes among patients who underwent a bioprosthetic valve replacement and were subsequently prescribed apixaban. Methods: A retrospective cohort study was completed for inpatients at a community hospital who were prescribed apixaban following a bioprosthetic valve replacement from 2015 to 2020. Endpoints assessed included incidence of all-cause readmission and emergency visits within 3 months following valvular surgery, incidence of mortality, and all-cause major and minor bleeding. A post hoc analysis was conducted comparing outcomes among patients who underwent mitral versus aortic valve replacement, as well as patients with and without atrial fibrillation. The study was deemed exempt by hospital and university institutional review boards. Results: A total of 54 patients were included for analysis. All-cause readmission or emergency visit occurred in 33% (n = 18) of patients and the mortality rate was 6% (n = 3). A minor bleeding event was reported in 6% (n = 3) of patients and a major bleeding event was reported in 2% (n = 1) of patients. A thrombotic event was reported in 2% (n = 1) of patients. Conclusion: Within this cohort of patients requiring anticoagulation following bioprosthetic valve replacement, apixaban was safe and well-tolerated. However, more prospective data are needed to further correlate the safety and efficacy of apixaban, particularly in the setting of mitral valve replacement.

scholarly journals Safety and efficacy of direct oral anticoagulants (DOACs) vs warfarin in patients with concurrent atrial fibrillation and bioprosthetic mitral or aortic valve replacement-a meta analysis

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
A Abdul Razzack ◽  
Y Sattar ◽  
S Pothuru ◽  
K Theja Reddy ◽  
K Teja Challa ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Valve Replacement ◽  
Major Bleeding ◽  
Fixed Effects ◽  
Meta Analysis ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Fixed Effects Model ◽  
Mechanical Valves ◽  
All Cause Mortality

Abstract Funding Acknowledgements Type of funding sources: None. Background- Bioprosthetic valve (BPV) implantation is preferred over mechanical valves for aortic and mitral valve replacement. BPV can have concurrent atrial fibrillation (AF). Primary advantage of BPV is the limited need of anticoagulation (AC) as compared to mechanical valves. However, recommendations for use of AC in BPV are not clear. Purpose We studied direct oral anticoagulants (DOACs) cardiovascular efficacy and safety in BPV as compared to Vitamin K antagonist (VKA, or warfarin). Methods- Electronic databases (PubMed, Embase, Scopus, Cochrane) were searched from inception to  November 28th, 2020. Using a generic invariance weighted fixed effects model, Hazard ratios (HRs) and their 95% confidence intervals (CIs) from individual studies were converted to Log HRs and corresponding standard errors, which were then pooled. The primary outcome of interest was  stroke or systemic embolisation (SSE), major bleeding and all-cause mortality. Results- A total of four studies with 1386 participants (DOACs n = 723  ; VKA n = 656) were included in analysis. Mean age was 63.7 and 62.4 years in the DOACs and VKA group respectively. Average follow-up period was 1 year and 4 months. DOACs were more efficacious than VKAs in stroke or  thromboembolism prevention (HR 0.43, 95%CI 0.20-0.94; p = 0.03). There was no difference in efficacy of DOACs as compared to VKAs in terms of major bleeding (HR 0.60; 95% CI 0.34-1.39; p = 0.09) and all-cause mortality (HR 0.99; 95%CI 0.57-1.7; p = 0.97) (Figure 1). We had no publication bias in our results (Egger’s regression p > 0.05). Conclusion- DOACs have similar mortality, and major bleeding risks as that of VKA at a benefit of higher stroke/thromboembolism prevention in patients with concurrent BPV and AF. Abstract Figure. A)SSE B)Major Bleeding C)Mortality

Abstract 17301: Safety of Direct Oral Anticoagulants Compared to Warfarin for Atrial Fibrillation After Cardiac Surgery: A Systematic Review and Meta-Analysis

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Ali Hage ◽  
Daniel Dolan ◽  
Viviane G Nasr ◽  
Luis Castelo-Branco ◽  
Daniel Motta-Calderon ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Trials ◽  
Cardiac Surgery ◽  
Hospital Readmission ◽  
Lower Risk ◽  
Meta Analysis ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Secondary Outcome ◽  
Systemic Embolization

Introduction: The evidence for use of direct oral anticoagulants (DOACs) in the management of post-operative cardiac surgery atrial fibrillation (POAF) is limited and mostly founded on clinical trials that excluded this patient population. Hypothesis: We performed a systematic review and meta-analysis of clinical trials and observational studies to evaluate the hypothesis that DOACs are safe compared to warfarin for the anticoagulation of patients with POAF. Methods: We searched PubMed, EMBASE, Web of Science, clinicaltrials.gov, and the Cochrane Library for clinical trials and observational studies comparing DOAC with warfarin in patients ≥18 years old who had post-cardiac surgery atrial fibrillation. Primary outcomes included stroke, systemic embolization, bleeding, and mortality, with secondary outcome of hospital readmission. We performed a random-effects meta-analysis. Results: We found 3 clinical trials, 1 prospective and 12 retrospective cohort studies eligible for inclusion with a total of 10,538 patients (3,207 DOAC patients and 7,331 warfarin patients). The meta-analysis for the primary outcomes showed significantly lower risk of stroke with DOAC use (6 studies, 7143 patients, RR 0.64; 95% CI 0.50 to 0.81, I2: 0.0%) compared to warfarin, a trend towards lower risk of systemic embolization (4 studies, 7289 patients, RR 0.64, 95% CI 0.41 to 1.01, I2: 31.99%) and similar risks of bleeding (14 studies, 10182 patients, RR 0.91; 95% CI 0.74 to 1.10, I2: 26.6%) and mortality (12 studies, 9843 patients, relative risk [RR] 1.01; 95% CI 0.74 to 1.37, I2: 26.5%) The secondary outcome of hospital readmission had similar risk between groups. Conclusions: Current evidence suggests that DOACs, compared to warfarin, in the management of atrial fibrillation after cardiac surgery is associated with lower risk of stroke and a strong trend for lower risk of systemic embolization, and no evidence of increased risk for hospital readmission, bleeding or mortality.

scholarly journals Direct oral anticoagulants versus vitamin K antagonists in patients with atrial fibrillation and cancer a meta-analysis

2020 ◽  
Author(s):  
Marco Valerio Mariani ◽  
Michele Magnocavallo ◽  
Martina Straito ◽  
Agostino Piro ◽  
Paolo Severino ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Vitamin K ◽  
Major Bleeding ◽  
Meta Analysis ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Significant Risk ◽  
Bleeding Complications ◽  
Efficacy And Safety

Abstract Background Direct oral anticoagulants (DOACs) are recommended as first-line anticoagulants in patients with atrial fibrillation (AF). However, in patients with cancer and AF the efficacy and safety of DOACs are not well established. Objective We performed a meta-analysis comparing available data regarding the efficacy and safety of DOACs vs vitamin K antagonists (VKAs) in cancer patients with non-valvular AF. Methods An online search of Pubmed and EMBASE libraries (from inception to May, 1 2020) was performed, in addition to manual screening. Nine studies were considered eligible for the meta-analysis involving 46,424 DOACs users and 182,797 VKA users. Results The use of DOACs was associated with reduced risks of systemic embolism or any stroke (RR 0.65; 95% CI 0.52–0.81; p 0.001), ischemic stroke (RR 0.84; 95% CI 0.74–0.95; p 0.007) and hemorrhagic stroke (RR 0.61; 95% CI 0.52–0.71; p 0.00001) as compared to VKA group. DOAC use was associated with significantly reduced risks of major bleeding (RR 0.68; 95% CI 0.50–0.92; p 0.01) and intracranial or gastrointestinal bleeding (RR 0.64; 95% CI 0.47–0.88; p 0.006). Compared to VKA, DOACs provided a non-statistically significant risk reduction of the outcomes major bleeding or non-major clinically relevant bleeding (RR 0.94; 95% CI 0.78–1.13; p 0.50) and any bleeding (RR 0.91; 95% CI 0.78–1.06; p 0.24). Conclusions In comparison to VKA, DOACs were associated with a significant reduction of the rates of thromboembolic events and major bleeding complications in patients with AF and cancer. Further studies are needed to confirm our results.

scholarly journals Direct Oral Anticoagulants in Patients With Atrial Fibrillation and Advanced Liver Disease: An Exploratory Meta‐Analysis

2020 ◽  
Vol 4 (7) ◽  
pp. 1034-1040 ◽  
Author(s):  
Francesco Violi ◽  
Annarita Vestri ◽  
Danilo Menichelli ◽  
Arianna Di Rocco ◽  
Daniele Pastori ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Liver Disease ◽  
Meta Analysis ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Advanced Liver Disease
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