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Warfarin faring better: Vitamin K antagonists beat rivaroxaban and apixaban in the INVICTUS and PROACT Xa trials
J Thromb Haemost. 2023 Jul 8:S1538-7836(23)00523-8. doi: 10.1016/j.jtha.2023.06.036. Online ahead of print.ABSTRACTAlthough guidelines give preference to the direct oral anticoagulants (DOACs) over vitamin K antagonists (VKAs) for stroke prevention in most patients with atrial fibrillation (AF), DOACs are not recommended in those with rheumatic heart disease or mechanical heart valves. The results of the INVICTUS trial (Investigation of Rheumatic AF Treatment Using Vitamin K Antagonists, Rivaroxaban or Aspirin Studies), which compared rivaroxaban with a VKA in patients with rheumatic heart disease associated AF, and the PR...
Source: Atherosclerosis - July 10, 2023 Category: Cardiology Authors: John W Eikelboom Jeffrey I Weitz Source Type: research

Can Warfarin be replaced by non-vitamin K anticoagulants in prosthetic valves?
In this report, the authors discussed the published data related to NOACs use in prosthetic valves highlighting the proposed mechanisms of NOACs failure and other controversial data regarding their efficacy and safety in prosthetic valves.EXPERT OPINION: Although NOACs have proven to be even safer and more effective alternatives to vitamin K antagonists (VKAs) in several indications for anticoagulation, the data regarding their safety and efficacy in prosthetic heart valves is still debatable. The controversial data regarding NOACs use in prosthetic valves renders it difficult to define specific guideline-recommendation fo...
Source: Expert Review of Cardiovascular Therapy - November 24, 2022 Category: Cardiology Authors: Mahmoud Abdelnabi Juthipong Benjanuwattra Ashraf Ahmed Abdallah Almaghraby Source Type: research

Comparison of Direct Oral Anticoagulants versus Warfarin in Patients with Atrial Fibrillation and Bioprosthetic Heart Valves
The objectives of this study were to evaluate the ambulatory utilization of DOACs and to compare the effectiveness and safety of DOACs versus warfarin in patients with AF and BHVs. We conducted a retrospective cohort study at a large integrated health care delivery system in California. Patients with BHVs and AF treated with warfarin, dabigatran, rivaroxaban or apixaban between September 12, 2011 and June 18, 2020 were identified.
Source: The American Journal of Cardiology - January 30, 2021 Category: Cardiology Authors: Lewei Duan, Jason N Doctor, John L Adams, John A Romley, Leigh-Anh Nguyen, Jaejin An, Ming-Sum Lee Source Type: research

Rivaroxaban Versus Warfarin in Patients with Mechanical Heart Valves: Open-Label, Proof-of-Concept trial —The RIWA study
ConclusionsIn this pilot study, rivaroxaban 15  mg twice daily had thromboembolic and bleeding events similar to warfarin in patients with mechanical heart valves. These data confirm the authors’ proof-of-concept and suggest that a larger trial with a similar design is not unreasonable.ClinicalTrial.gov identifierNCT03566303.
Source: American Journal of Cardiovascular Drugs - November 5, 2020 Category: Cardiology Source Type: research

Novel oral anticoagulant vs. warfarin in elderly atrial fibrillation patients with normal, mid ‐range, and reduced left ventricular ejection fraction
ConclusionsIn elderly AF patients ≥65 years, using NOAC was associated with lower IS/SE compared with warfarin in normal and mid‐range LVEF but not in reduced LVEF. Using NOACs was associated with lower death compared with warfarin in normal LVEF.
Source: ESC Heart Failure - July 15, 2020 Category: Cardiology Authors: Victor Chien ‐Chia Wu, Chun‐Li Wang, Cheng‐Hung Lee, Yu‐Ling Chen, Hui‐Tzu Tu, Michael Wu, Chang‐Fu Kuo, Shao‐Wei Chen, Yu‐Tung Huang, Ming‐Shien Wen, Shang‐Hung Chang Tags: Original Research Article Source Type: research

Can Direct Oral Anticoagulants Be Used for Stroke Prevention Among Patients with Valvular Atrial Fibrillation?
AbstractPurpose of ReviewTo review the clinical evidence underlying the efficacy and safety of the use of direct oral anticoagulants (DOACs) for the treatment of patients with valvular atrial fibrillation (AF).Recent FindingsThe recent focused update to the 2014 AHA/ACC/HRS Atrial Fibrillation Guidelines defines valvular AF as AF in the setting of moderate-to-severe mitral stenosis (MS) and/or in the presence of a mechanical heart valve. Landmark clinical trials of DOACs in patients with AF systematically excluded these patient populations. However, there are trial data in both animals and humans regarding the use of DOACs...
Source: Current Cardiology Reports - August 30, 2019 Category: Cardiology Source Type: research

Comparative effectiveness, safety, and costs of rivaroxaban and warfarin among morbidly obese patients with atrial fibrillation
ConclusionsMorbidly obese AF patients treated with rivaroxaban had comparable risk of ischemic stroke/systemic embolism and major bleeding as those treated with warfarin, but lower healthcare resource utilization and costs.
Source: American Heart Journal - February 21, 2019 Category: Cardiology Source Type: research

INR Control of Patients with Mechanical Heart Valve on Long-Term Warfarin Therapy
ConclusionsDespite a majority of patients having <60% TTR, there were low incidences of bleeding and stroke events in this center. There were no factors found to be associated with INR control in this study.
Source: Global Heart - September 11, 2018 Category: Cardiology Source Type: research

Direct oral anticoagulant use in nonvalvular atrial fibrillation with valvular heart disease: a systematic review
In conclusion, subanalyses of DOAC landmark AF trials revealed that dabigatran, rivaroxaban, and apixaban may be safely used in AF patients with certain types of VHD: aortic stenosis, aortic regurgitation, and mitral regurgitation. More evidence is needed before routinely recommending these agents for patients with bioprosthetic valves or mild mitral stenosis. Patients with moderate to severe mitral stenosis or mechanical valves should continue to receive warfarin, as these patients were excluded from all landmark AF trials.
Source: Clinical Cardiology - December 21, 2016 Category: Cardiology Authors: Ryan E. Owens, Rajesh Kabra, Carrie S. Oliphant Tags: Reviews Source Type: research

Anticoagulation After Biological Aortic Valve Replacement: Is There An Optimal Regimen?
CONCLUSIONS: Plasma anticoagulation with warfarin during the early postoperative phase was shown statistically to be inferior to platelet aggregation inhibition by aspirin with regards to postoperative bleeding risk, cerebral ischemic events, and survival. PMID: 27989055 [PubMed - in process]
Source: Journal of Heart Valve Disease - December 21, 2016 Category: Cardiology Tags: J Heart Valve Dis Source Type: research

Antithrombotic drug use: scientific breakthroughs, biological limits and physician behaviour
During the past 25 years, there has been a dramatic surge in the use of antithrombotic drugs as documented in the Heart paper by Adelborg et al.1 The authors derived their findings from the Danish drug utilisation database, which is unique in its comprehensiveness and ability to capture over-the-counter aspirin. The increased prescription of antithrombotic drugs is fuelled by a better understanding of disease and risk, population growth, ageing societies, improved methods of detection, and rising global rates of obesity, a recognised risk factor for atrial fibrillation (AF), venous thromboembolic (VTE) disease, and ca...
Source: Heart - November 10, 2016 Category: Cardiology Authors: Hylek, E. M. Tags: Drugs: cardiovascular system, Venous thromboembolism, Epidemiology Editorials Source Type: research

Practical Considerations for the Nonvitamin K Antagonist Oral Anticoagulants
Conclusions: Several important factors should be considered regarding the adequate use of NOACs, especially in patients with renal impairment or cardiovascular conditions other than NVAF.Cardiology 2017;136:115-124
Source: Cardiology - September 5, 2016 Category: Cardiology Source Type: research

Incidence and risk factors for thromboembolism and major bleeding in patients with mechanical valve prosthesis; a nationwide population-based study
Conclusions In a nationwide cohort study with MHV and high TTR, heart failure and atrial fibrillation did not appear as risk factors of stroke/TE.
Source: American Heart Journal - August 11, 2016 Category: Cardiology Source Type: research

Comparison of Dabigatran versus Warfarin in Patients with Atrial Fibrillation and Valvular Heart Disease: The RE-LY Trial.
CONCLUSIONS: -The presence of any VHD did not influence the comparison of dabigatran with warfarin. Clinical Trial Registration-URL: http://clinicaltrials.gov. Unique Identifier: NCT00262600. PMID: 27496855 [PubMed - as supplied by publisher]
Source: Circulation - August 4, 2016 Category: Cardiology Authors: Ezekowitz MD, Nagarakanti R, Noack H, Brueckmann M, Litherland C, Jacobs M, Clemens A, Reilly PA, Connolly SJ, Yusuf S, Wallentin L Tags: Circulation Source Type: research

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