Key result
New oral anticoagulants significantly reduced the risk of stroke and systemic embolism (RR 0.78) compared with warfarin in patients with atrial fibrillation and valvular heart disease.
Why the study?
NOACs are approved for nonvalvular AF, but their efficacy and safety compared with warfarin in patients with AF and valvular heart disease needed evaluation.
Do new oral anticoagulants (NOACs) reduce stroke and systemic embolism in patients with atrial fibrillation and valvular heart disease compared to warfarin?
Meta-Analysis (n=13,850)
Do new oral anticoagulants (NOACs) reduce stroke and systemic embolism in patients with atrial fibrillation and valvular heart disease compared to warfarin?
Relative Risk: 0.78 (95% CI 0.66–0.91)
p-value: p=0.002
In patients with atrial fibrillation and valvular heart disease, NOACs significantly reduce the risk of stroke, systemic embolism, and intracranial hemorrhage compared to warfarin, with a similar or lower risk of major bleeding.
Supports preferring NOACs over warfarin for stroke prevention in AF with valvular disease; extends RCT evidence to this subgroup.
New oral anticoagulants (NOACs) are approved for use in nonvalvular atrial fibrillation (AF). This study aimed to evaluate the efficacy and safety of NOACs compared with warfarin in AF and valvular heart disease (VHD). We identified randomized controlled trials (RCTs) and post-hoc analyses comparing NOACs and warfarin in AF and VHD, including biological and mechanical heart valves (MHV). Through systematic review and meta-analysis, with the aid of the “Rev Man” program 5.3, the primary effectiveness endpoints were stroke and systemic embolism (SE). The primary safety outcome was major bleeding, and the secondary outcome included intracranial hemorrhage. Data were analyzed using risk ratios (RRs) and 95% confidence intervals (CIs), and heterogeneity was assessed using the I 2 statistic. Six RCTs were included, involving 13,850 patients with AF and VHD. NOACs significantly reduced the risk of stroke/SE (RR 0.78; 95% CI 0.66–0.91; P = 0.002) and intracranial hemorrhage (RR 0.51; 95% CI 0.33–0.79; P = 0.003) and lowered the risk of major bleeding (RR 0.77; 95% CI 0.58–1.02; P = 0.07) compared with warfarin. The efficacy and safety of NOACs as thromboprophylaxis for AF and VHD are similar to those of warfarin.
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Bitar et al. (2019) conducted a meta-analysis in Atrial Fibrillation and Valvular Heart Disease (n=13,850). New oral anticoagulants (NOACs) vs. Warfarin was evaluated on Stroke and systemic embolism (RR 0.78, 95% CI 0.66-0.91, p=0.002). New oral anticoagulants significantly reduced the risk of stroke and systemic embolism (RR 0.78) compared with warfarin in patients with atrial fibrillation and valvular heart disease.
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