Abstract 13931: Direct Oral Anticoagulants in Atrial Fibrillation Patients With Rheumatic Heart Disease After Mitral Valve Replacement With Bioprosthesis

Abstract

Background: We sought to investigate the outcomes of direct oral anticoagulants (DOACs) versus warfarin in patients with atrial fibrillation and bioprosthetic mitral valve replacement (bMVR) due to rheumatic heart disease. Methods: We performed a retrospective study using the TriNetX global database to identify patients with atrial fibrillation and bMVR due to rheumatic heart disease from 2010 to 2020. Patients who had mechanical mitral or aortic valve replacement were excluded. Patients were stratified into 2 groups: DOAC group and Warfarin group. 1:1 propensity-score matching to control for baseline differences between the two groups was performed. The primary endpoint was ischemic stroke and secondary endpoints were all-cause mortality, major bleeding, myocardial infarction, and all-cause hospitalization over a mean follow-up of 3 years. Results: A total of 2,011 patients were identified and 586 were included after propensity-score matching (293 patients in each group). Patients in the DOAC group, compared to the warfarin group aged 68.9 ± 11.2 vs 68.2 ± 11 years (P=0.41) and 63.4% vs 63.8% were females (P=0.93). There was no significant difference between the two groups in ischemic stroke, all-cause mortality, major bleeding, myocardial infarction, and all-cause hospitalization. (Table 1, figure 1). Conclusion: In patients with atrial fibrillation and bMVR due to rheumatic heart disease, DOACs use was associated with similar rates of ischemic stroke, mortality, major bleeding, myocardial infarction, or hospitalization compared to warfarin.