ACOD en pacientes con fibrilación auricular e intervención quirúrgica sobre la válvula mitral

Abstract

Introduction and objectivesAlthough the usage of direct oral anticoagulants (DOAC) in patients with atrial fibrillation (AF) and intervention on the mitral valve (biological valve prosthesis or repair) is included in the clinical practice guidelines as an alternative to vitaminK antagonists (VKA), real world data in this scenario remain scarce. MethodsOur study included all patients who underwent mitral valve replacement by biological prosthesis or mitral valve repair in our hospital between 2014 and 2020, with indication of anticoagulation due to AF. We compared rates of cerebrovascular events, major and minor bleeding, and mortality, between those treated with DOACs and VKAs. ResultsWe selected 105 patients: 75 submitted to biological replacement and 30 to repair. After a mean follow-up of 2.8years, 41 patients were treated exclusively with VKA, and 64 started DOACs —34 as anticoagulant from the beginning, and 30 after switching from VKA. There were no significant differences in their baseline clinical characteristics in terms of age, sex, kidney function, or embolic or bleeding risk scales between groups. There were no differences in the rate of stroke and major bleeding between patients with VKA or DOAC (major bleeding, VKA n=6, 8.4% vs DOAC n=4, 11.7%; stroke/TIA, VKA n=5, 7.04% vs DOAC 2, 5.8%), with 2 intracranial hemorrhages under VKA (2.8%). ConclusionsThe use of DOACs in a real-life cohort of patients with mitral valve surgery (biological prosthesis or repair) is an effective and safe alternative to the use of VKAs, without differences in the rate of ischemic or hemorrhagic events.