SHM Converge Scientific Abstract ePoster Gallery-Warfarin Versus Novel Anticoagulants in Patients With Artificial Heart Valves

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This document summarizes a systematic review and meta-analysis comparing novel oral anticoagulants (NOACs) with warfarin in adults with artificial heart valves, including both mechanical and bioprosthetic valves. The authors searched literature through May 2022 and included randomized trials and retrospective cohort studies that directly compared outcomes between the two drug classes.<br /><br />Eight studies were included, involving 183,167 patients, of whom 38% were female. Most patients had bioprosthetic valves, while fewer had mechanical valves. The main outcomes analyzed were bleeding, mortality, transient ischemic attack (TIA), systemic embolism, all-stroke, ischemic stroke, and major bleeding.<br /><br />Overall, NOACs and warfarin showed no significant difference in all bleeding, all-cause mortality, TIA, systemic embolism, or all-stroke. However, NOACs were associated with less major bleeding and less ischemic stroke than warfarin overall. Specifically, warfarin caused 22% more major bleeding and 72% more ischemic stroke compared with NOACs.<br /><br />Subgroup analyses suggested different effects by valve type. In patients with bioprosthetic valves, warfarin was associated with more major bleeding than NOACs. In patients with mechanical valves, NOACs appeared to cause more major bleeding than warfarin, suggesting warfarin may be safer in this group. The findings also suggested that NOACs may be better for bioprosthetic valves, but not for mechanical valves.<br /><br />The authors note important limitations: few available studies, heterogeneity across studies, limited INR data, and grouping different NOACs together. They conclude that NOACs may be a reasonable or better alternative for bioprosthetic valves, but warfarin remains preferred for mechanical valves. More targeted trials are needed, especially in mechanical valve patients.

Asset Subtitle

Umesh Sharma

Meta Tag

Author List Diana Almader-Douglas, Salil Deo, Umesh Sharma, Yeju Srivastava

Category Research

Concept Direct Oral Anticoagulant

Concept Warfarin

Concept Artificial Heart Valves

Concept Mechanical Heart Valve

Concept Bioprosthetic Heart Valve

Distinguished Non-Finalist

Presenter Organization Mayo Clinic Arizona

Presenting Author Umesh Sharma

Track Outcomes Research

Keywords

novel oral anticoagulants

warfarin

artificial heart valves

mechanical valves

bioprosthetic valves

systematic review

meta-analysis

major bleeding

ischemic stroke

anticoagulation therapy

Direct Oral Anticoagulant

Warfarin

Artificial Heart Valves

Mechanical Heart Valve

Bioprosthetic Heart Valve