Efficacy and safety of novel oral anticoagulants in patients with bioprosthetic valves

Purpose Prosthetic valve replacement is performed in several hundred thousand patients worldwide annually, and many of these patients have or will ultimately develop atrial fibrillation or flutter (AF). Novel oral anticoagulants (NOACs) are not recommended in patients with AF and mechanical valves b...

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Bibliographic Details
Published in:Clinical research in cardiology 2016-03, Vol.105 (3), p.268-272
Main Authors: Yadlapati, Ajay, Groh, Christopher, Malaisrie, S. Chris, Gajjar, Mark, Kruse, Jane, Meyers, Sheridan, Passman, Rod
Format: Article
Language:English
Subjects:
Administration, Oral
Aged
Anticoagulants - administration & dosage
Anticoagulants - adverse effects
Atrial Fibrillation - complications
Atrial Fibrillation - diagnosis
Atrial Fibrillation - drug therapy
Atrial Flutter - complications
Atrial Flutter - diagnosis
Atrial Flutter - drug therapy
Bioprosthesis
Cardiology
Female
Heart Valve Prosthesis
Heart Valve Prosthesis Implantation - adverse effects
Heart Valve Prosthesis Implantation - instrumentation
Hemorrhage - chemically induced
Humans
Ischemic Attack, Transient - diagnosis
Ischemic Attack, Transient - etiology
Ischemic Attack, Transient - prevention & control
Male
Medicine
Medicine & Public Health
Middle Aged
Original Paper
Prosthesis Design
Retrospective Studies
Risk Factors
Stroke - diagnosis
Stroke - etiology
Stroke - prevention & control
Thromboembolism - diagnosis
Thromboembolism - etiology
Thromboembolism - prevention & control
Time Factors
Treatment Outcome
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Summary:Purpose Prosthetic valve replacement is performed in several hundred thousand patients worldwide annually, and many of these patients have or will ultimately develop atrial fibrillation or flutter (AF). Novel oral anticoagulants (NOACs) are not recommended in patients with AF and mechanical valves but have not been evaluated in patients with bioprosthetic valves. This study sought to evaluate the efficacy and safety of NOACs in patients with AF and bioprosthetic valves. Methods A retrospective single-center cohort study was performed on all patients with bioprosthetic valve implantation, for whom a NOAC was prescribed for the indication of AF. Patients were evaluated for thromboembolic events including imaging confirmed ischemic stroke, clinically suspected transient ischemic attack, and major bleeding events (according to International Society on Thrombosis and Hemostasis definition). Results In total, 73 patients (26 female, 35.6 %) were identified. NOAC therapy began, on average, 990.0 ± 1029.1 days after bioprosthetic valve implantation for an average duration of 511.8 ± 400.8 days. Aspirin was used concomitantly in a majority of patients (72.6 %). There were no ischemic strokes identified (0.0 %) and one possible TIA (1.4 %). There were 6 (8.2 %) minor and 5 (6.9 %) major bleeding events. Conclusion The use of NOAC therapy for AF in patients with bioprosthetic valves appears safe and effective in the occurrence of thromboembolic events, however, at the expense of increased bleeding. Larger studies are necessary to confirm these findings.
ISSN:1861-0684
1861-0692
DOI:10.1007/s00392-015-0919-z