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Outcomes of Direct Oral Anticoagulants in Patients with Atrial Fibrillation and Valvular Heart Disease

  • Invasive Electrophysiology and Pacing (EK Heist, Section Editor)
  • Published:
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Abstract

Purpose of Review

Direct oral anticoagulants (DOACs) are increasingly used for the treatment and prevention of thromboembolic events in patients with non-valvular atrial fibrillation (AF). Evidence regarding their role in patients with AF and concurrent valvular heart disease (VHD) continues to evolve.

Recent Findings

Post hoc analyses of randomized clinical trials suggest that DOACs are non-inferior to warfarin for the prevention of stroke or systemic embolism in patients with AF and VHD. Emerging evidence from observational data showed a favorable benefit-risk profile for DOACs compared to warfarin in patients with AF and VHD.

Summary

DOACs are an attractive option for the treatment of patients with AF and VHD who cannot tolerate or have contraindications to warfarin therapy. Future studies are needed to evaluate their effectiveness, safety, and examine variability in the direction and magnitude of treatment effects in selected VHD subgroups.

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Authors and Affiliations

  1. Center for Pharmacoepidemiology Research and Training, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    Ghadeer K. Dawwas

  2. Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, 423 Guardian Drive, Philadelphia, PA, 19104-4865, USA

    Ghadeer K. Dawwas

  3. Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA

    Ghadeer K. Dawwas

  4. Division of Cardiovascular Medicine, Department of Internal Medicine, Frankel Cardiovascular Center, University of Michigan Health System, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd, Building #14, Room G214, Ann Arbor, MI, 48109, USA

    Geoffrey D. Barnes

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Correspondence to Ghadeer K. Dawwas.

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Conflict of Interest

GKD receives funding from the American Society of Hematology and the National Institutes of Health. GDB has served as a consultant for Pfizer/Bristol-Myers Squibb, Janssen, and Acelis Connected Health.

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Dawwas, G.K., Barnes, G.D. Outcomes of Direct Oral Anticoagulants in Patients with Atrial Fibrillation and Valvular Heart Disease. Curr Cardiol Rep 24, 731–738 (2022). https://doi.org/10.1007/s11886-022-01690-9

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