Meta-Analysis Comparing Direct Oral Anticoagulants Versus Vitamin K Antagonists in Patients With Atrial Fibrillation Who Underwent Bioprosthetic Valve Replacement

Abstract

Anticoagulation strategies in patients with atrial fibrillation (AF) who underwent bioprosthetic valve replacement are still controversial. Despite dramatic increase in volume, postoperative anticoagulation continues to be a challenge. 1 Colli A Verhoye JP Leguerrier A Gherli T. Anticoagulation or antiplatelet therapy of bioprosthetic heart valves recipients: an unresolved issue. Eur J Cardiothorac Surg. 2007; 31: 573-577 Google Scholar Promising data accumulated for use of direct oral anticoagulants (DOACs) in nonvalvular AF; 2 De Caterina R Camm AJ. What is ‘valvular’ atrial fibrillation? A reappraisal. Eur Heart J. 2014; 35: 3328-3335 Google Scholar however, there is no clear consensus regarding valvular AF, and the recommendations for use of vitamin K antagonists (VKAs) and/or DOACs in patients with bioprosthetic valves have been guided by limited evidence from small, underpowered randomized controlled trials (RCTs). 3 Durães AR Durães MA Correia LC Aras R. Antithrombotic strategy in the three first months following bioprosthetic heart valve implantation. Arq bras cardiol. 2013; 101: 466-472 Google Scholar It is uncertain whether VKA and the newer, more convenient DOAC are comparable in this subset of patients. Therefore, we conducted a meta-analysis of RCTs to assess the efficacy and safety of DOAC versus VKA in patients with AF who underwent bioprosthetic valve replacement.