ACOD frente a AVK en pacientes con fibrilación auricular y recambio valvular aórtico por bioprótesis

Abstract

Introduction and objectivesAlthough the usage of direct oral anticoagulants (DOAC) in patients with atrial fibrillation (AF) and bioprosthesis is already accepted in recent guidelines as an alternative to vitamin K antagonists (VKA), real world data in this scenario remain scarce, even more in our country. MethodsA retrospective single-center study that included all consecutive patients who underwent aortic valve replacement with bioprosthetic heart valve from 2013 to 2018, with oral anticoagulation initiated because of AF. The rates of occurrence of thromboembolic events (ischemic stroke, transient ischemic attack), major and minor although clinically relevant bleed, intracranial hemorrhage and death were assessed in patients on DOAC vs VKA. ResultsA total of 132 patients on VKA (62.6%) and 79 on DOACs (37.4%; apixaban 20%, edoxaban 10%, rivaroxaban 6% and dabigatran 3%) were included in the study. There were no significant differences in baseline clinical characteristics (age, sex, renal function or embolic risk scales). Mean follow-up was 32.85±15 months. The incidence-rates of cerebrovascular/thromboembolic events were 1.5/100 persons-year in the DOAC group 1.32 in the VKA group. The incidence-rates of major bleed 2.02/100 persons-year in DOACs group vs 3.7 in VKA group. Patients in the VKA group experienced 6 intracranial hemorrhages vs none in the DOAC group. ConclusionsAccording to our data from clinical practice, DOAC in patients with AF and a bioprosthetic heart valve seem to be a safe and effective alternative to VKA.