Do direct oral anticoagulants reduce stroke or systemic embolism compared to vitamin K antagonists in patients with bioprosthetic valves?
In patients with bioprosthetic valves, DOACs significantly reduce the risk of stroke or systemic embolism compared to VKAs without increasing the risk of major bleeding.
BackgroundReplacing bioprosthetic valves is common but can cause coagulation issues. This study assesses the safety and efficacy of Direct oral anticoagulants (DOACs) versus vitamin K antagonists (VKAs) in bioprosthetic valve procedures.MethodsPubMed, Cochrane Central, and ScienceDirect were searched till May 2025. The risk ratios (RRs) were pooled with 95% confidence intervals (CIs) under the random effects model using Review Manager software. The quality assessment was conducted using the Cochrane risk of bias (RoB 2.0) tool.ResultsEight randomized controlled trials involving 3863 patients were included in the meta-analysis. DOACs were associated with a significant reduction in the risk of stroke or systemic embolism compared with VKAs (RR = 0.48; 95%CI: 0.26, 0.88; p = .02). The rate of major bleeding was similar between the DOACs and VKAs (RR = 0.92; 95%CI: 0.49, 1.72; p = .79). There was no significant difference in the incidence of any stroke between the two groups (RR = 0.65; 95%CI: 0.32, 1.31; p = .23). The occurrence of clinically relevant non-major bleeding (RR = 1.17; 95%CI: 0.97, 1.40; p = .10), all-cause mortality (RR = 0.94; 95%CI: 0.75, 1.17; p = .57), and intracranial hemorrhage (ICH) (RR = 0.71; 95%CI: 0.40, 1.26; p = .25) were comparable between the groups.ConclusionDOACs seem safe after bioprosthetic valve implantation, lowering the risk of stroke or systemic embolism. However, rates of major bleeding, clinically relevant non-major bleeding, any stroke, ICH, and all-cause mortality were comparable between DOACs and VKAs.
Waseem et al. (2026) studied this question.