Universität zu Köln

Gerfer, Stephen ORCID: 0000-0002-6568-6766, Djordjevic, Ilija ORCID: 0000-0002-5810-8626, Eghbalzadeh, Kaveh, Mader, Navid, Wahlers, Thorsten and Kuhn, Elmar (2022). Direct oral anticoagulation in atrial fibrillation and heart valve surgery - a meta-analysis and systematic review. Ther. Adv. Cardiovasc. Dis., 16. LONDON: SAGE PUBLICATIONS LTD. ISSN 1753-9455

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Abstract

Aims: Oral anticoagulation with direct oral anticoagulants (DOAC) could provide an alternative to vitamin K antagonists (VKA) for patients with atrial fibrillation (AF) undergoing bioprosthetic heart valve replacement or valve repair. Methods and results: The aim of this meta-analysis was to review the safety and efficacy of DOAC in patients with surgical implanted bioprosthetic heart valves or valve repairs and AF including data from six clinical trials with a total of 1,857 patients. The efficacy and safety data of DOAC and VKA were pooled to perform random-effects meta-analyses using the Mantel-Haenszel method with pooled risk ratios (RR) and 95% confidence interval (CI). A trial sequential analysis (TSA) was performed to assess statistical robustness. Death caused by cardiovascular cause or thromboembolic events were comparable (RR 0.67, 95% CI: 0.42-1.08; p= 0.101 as DOAC significantly reduced the risk for major bleeding (RR 0.55, 95% CI: 0.35-0.88; p = 0.01) and thromboembolic stroke or systemic embolism rates (RR 0.54, 95% CI: 0.32-0.90; p= 0.021. Rates for intracranial bleeding and hemorrhagic stroke (RR 0.27, 95% CI: 0.07-0.99; p= 0.051 show a trend toward fewer events in the DOAC group. Outcomes for major or minor bleeding events and all-cause mortality were comparable for DOAC and VKA. Conclusion: Cumulative data analysis reveals that DOAC may provide an effective and safe alternative to VKA in patients with AF after surgically implanted bioprosthetic heart valves or repair with AF. Within a relatively heterogeneous study population, this meta-analysis shows a risk reduction of major bleedings and thromboembolic stroke or systemic embolisms for DOAC.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Gerfer, Stephen UNSPECIFIED orcid.org/0000-0002-6568-6766 UNSPECIFIED Djordjevic, Ilija UNSPECIFIED orcid.org/0000-0002-5810-8626 UNSPECIFIED Eghbalzadeh, Kaveh UNSPECIFIED UNSPECIFIED UNSPECIFIED Mader, Navid UNSPECIFIED UNSPECIFIED UNSPECIFIED Wahlers, Thorsten UNSPECIFIED UNSPECIFIED UNSPECIFIED Kuhn, Elmar UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-659195
DOI:	10.1177/17539447221093963
Journal or Publication Title:	Ther. Adv. Cardiovasc. Dis.
Volume:	16
Date:	2022
Publisher:	SAGE PUBLICATIONS LTD
Place of Publication:	LONDON
ISSN:	1753-9455
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language TRIAL SEQUENTIAL-ANALYSIS; WARFARIN; EDOXABAN; RIVAROXABAN; DABIGATRAN; APIXABAN Multiple languages Cardiac & Cardiovascular Systems Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/65919