Abstract P2137: Comparative Effectiveness And Safety Of Rivaroxaban Versus Warfarin In Valvular Atrial Fibrillation: A Systematic Review And Meta-Analysis

Abstract

Introduction: Patients with valvular atrial fibrillation (AF), which refers to moderate to severe mitral stenosis or mechanical prosthetic heart valves, have an increased risk of ischemic stroke and systemic embolism, which mandates the need for long-term anticoagulation. Still, there are no clear consensus guidelines on the indications of anticoagulation therapy in valvular AF. We aimed to compare the effectiveness of rivaroxaban, a common direct-acting oral anticoagulant (DOAC), to warfarin for preventing thromboembolism in valvular AF patients. Methods: We performed a systematic search of the following databases; PubMed, Cochrane Library, Google Scholar, and EMBASE from inception until February 06, 2023. Results: After screening 389 studies, 8 studies with 68,847 patients have been included in the final analysis. Our meta-analysis did not reveal a significant difference in the occurrence of all-cause mortality between patients who received rivaroxaban and those who received warfarin [RR, 0.97 (95% CI: 0.53-1.76]), p =0.91]. On analysis of the individual studies, rivaroxaban was non-inferior to warfarin with a lower risk of bleeding events [RR, 0. 80 (95% CI: 0.62-1.04), p =0.72], myocardial infarction [RR, 0.56 (95% CI: 0.13-2.47), p =0.44], and stroke/systemic embolism [RR, 0.54 (95% CI: 0. 11-2.55), p = 0.43]. But there was no statistically significant difference between the two groups. Conclusions: With a decreased risk for major adverse events, rivaroxaban appears to have a favorable safety profile, making them a promising alternative to warfarin in treating patients with valvular AF. However, more randomized clinical trials are imperative.