Do direct oral anticoagulants reduce thromboembolic or bleeding events compared to vitamin K antagonists in adults undergoing bioprosthetic mitral or aortic valve replacement or repair?
In patients undergoing bioprosthetic valve replacement or repair, DOACs demonstrated similar rates of thromboembolic and bleeding events compared to VKAs in the early postoperative period.
Vitamin K antagonists are used as a temporary anticoagulation method after bioprosthetic valve replacement or repair. However, the novel direct oral anticoagulants may be a preferred method of anticoagulation because of their improved patient compliance. This meta-analysis aimed to evaluate the safety of direct oral anticoagulants versus vitamin K antagonists after biological valve replacement or repair. A systematic review and meta-analysis were performed for studies reporting the effect of direct oral anticoagulants versus vitamin K antagonists after biological valve replacement or repair. The inclusion criteria were studies of adults undergoing bioprosthetic mitral or aortic valve replacement or repair, comparing direct oral anticoagulants versus vitamin K antagonists in the early postoperative period. The main outcomes were thromboembolic and bleeding events, and short- and mid-term death rates. Six observational studies and one randomized controlled trial were included, with a total of 2994 direct oral anticoagulant recipients and 16,894 vitamin K antagonist recipients. There were no significant differences between the groups in terms of thromboembolic events (odds ratio: 0.82, 95% confidence interval: 0.45-1.49; P=0.52) or bleeding events (odds ratio: 0.89, 95% confidence interval: 0.70-1.14, P=0.36). Higher 30-day and mid-term death rates were observed in patients receiving direct oral anticoagulants, but this analysis was reported inconsistently, and was heavily influenced by a single study. In a mixed population of individuals undergoing bioprosthetic valve replacement or repair, there was no statistically significant difference between direct oral anticoagulants and vitamin K antagonists in terms of reducing thromboembolic or bleeding events. Further studies are needed to establish the optimal anticoagulation regimen in this context.
Bruno et al. (2026) studied this question.