Non-vitamin K antagonist oral anticoagulants are safe for atrial fibrillation patients with bioprosthetic valves, but dabigatran is harmful in patients with mechanical prosthetic mitral valves.
Do non-vitamin K antagonist oral anticoagulants provide safe and effective stroke prophylaxis compared to vitamin K antagonists in patients with atrial fibrillation and valvular heart disease?
This review clarifies that NOACs are safe and recommended for AF patients with most valvular heart diseases, including bioprosthetic valves, but are harmful in those with mechanical prosthetic mitral valves.
The non-vitamin K antagonist oral anticoagulants (NOACs) dabigatran, rivaroxaban, apixaban, and edoxaban have transformed the management of atrial fibrillation (AF), but are only approved by regulatory authorities for stroke prophylaxis in patients with so-called "non-valvular AF." This terminology has spawned confusion about which patients with valvular heart disease benefit from NOACs and which should be treated with vitamin K antagonists (VKAs) instead. Patients with valvular heart disease other than mechanical prosthetic valves or severe mitral stenosis (including those with bioprosthetic valves) were included in pivotal trials demonstrating the benefit of NOACs over VKAs, and consensus guidelines recommend NOACs over VKAs in these patients. Subsequent devoted randomized controlled trials in patients with AF and bioprosthetic valves, including transcatheter valves, have confirmed the safety of NOACs in this population. In patients with rheumatic mitral stenosis, observational studies indicate that NOACs may be safe and effective, but randomized controlled trials are ongoing. By contrast, a randomized controlled trial showed that dabigatran is harmful in patients with mechanical prosthetic mitral valves; however, these data may not extrapolate to patients with mechanical valve prostheses in other locations or to other NOACs, and randomized controlled trials are ongoing. In this review, we discuss these data in greater depth, and make recommendations for the use of NOACs in patients with valvular heart disease.
Fanaroff et al. (Tue,) conducted a review in Valvular heart disease and atrial fibrillation. Non-vitamin K antagonist oral anticoagulants (NOACs) vs. Vitamin K antagonists (VKAs) was evaluated. Non-vitamin K antagonist oral anticoagulants are safe for atrial fibrillation patients with bioprosthetic valves, but dabigatran is harmful in patients with mechanical prosthetic mitral valves.