Meta-Analysis Comparing Direct Oral Anticoagulants Versus Vitamin K Antagonists in Patients With Atrial Fibrillation Who Underwent Bioprosthetic Valve Replacement

Despite dramatic increase in volume, postoperative anticoagulation continues to be a challenge.1 Promising data accumulated for use of direct oral anticoagulants (DOACs) in nonvalvular AF;2 however, there is no clear consensus regarding valvular AF, and the recommendations for use of vitamin K antagonists (VKAs) and/or DOACs in patients with bioprosthetic valves have been guided by limited evidence from small, underpowered randomized controlled trials (RCTs).3 It is uncertain whether VKA and the newer, more convenient DOAC are comparable in this subset of patients. [...]we conducted a meta-analysis of RCTs to assess the efficacy and safety of DOAC versus VKA in patients with AF who underwent bioprosthetic valve replacement. DOACs have a better pharmacologic profile in terms of feasibility and convenience.7 Limitations of our study include limited numbers of trials, lack of patient level data, and underrepresentation of non-White ethnicity. [...]among patients with AF who underwent bioprosthetic valve replacement, anticoagulation strategy with DOAC might represent an alternative to VKA strategy, with a similar safety and efficacy profile.Disclosures The authors have no conflicts of interest to declare.Funding None.