Key result
Direct-acting oral anticoagulants (DOACs) for mechanical and bioprosthetic heart valves currently lack data from well-designed clinical trials, warranting vigilance and future randomized studies.
Why the study?
Despite increasing DOAC use in mechanical and bioprosthetic heart valves, clinical practice shows notable heterogeneity in antithrombotic regimens, prompting a review of clinical guidelines and emerging data.
What is the role of DOACs in patients with mechanical and bioprosthetic heart valves?
What is the role of DOACs in patients with mechanical and bioprosthetic heart valves?
This narrative review underscores the emerging but currently undefined role of DOACs in patients with mechanical and bioprosthetic heart valves, calling for vigilance until robust RCT data are available.
Rising DOAC use in VHD requires caution for mechanical valves; leaves open need for RCTs to guide practice.
In the recent years, there has been significant transformation in the management of valvular heart disease (VHD), as a result of new minimally invasive technologies, such as the transcatheter aortic valve implantation (TAVI). Conventionally, mechanical heart valves require anticoagulation with warfarin to prevent thrombogenic events. Lately, there has been an uptrend in the usage of direct-acting oral anticoagulants (DOACs) in both mechanical and bioprosthetic heart valves. In clinical practice, there has shown to be notable heterogeneity in the antithrombotic regimen for patients. Recommendations from clinical guidelines and emerging data on DOAC use in these settings will be critically reviewed here. Future large, randomized-controlled trials are warranted to delineate the role of DOACs in patients receiving a bioprosthetic valve/TAVI or mechanical heart valve, with and without a baseline indication for anticoagulation or antiplatelets. Until clinical trial data from well-designed studies are available, providers must remain vigilant about DOAC use in patients with VHD, especially in patients with a bioprosthetic or mechanical heart valve.
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Ryu et al. (2022) conducted a review in Valvular heart disease with mechanical or bioprosthetic heart valves. Direct-acting oral anticoagulants (DOACs) vs. Warfarin was evaluated. Direct-acting oral anticoagulants (DOACs) for mechanical and bioprosthetic heart valves currently lack data from well-designed clinical trials, warranting vigilance and future randomized studies.
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