Non-vitamin K antagonist oral anticoagulants in atrial fibrillation patients with bioprosthetic valves

ABSTRACT

Introduction: The non-vitamin K antagonist oral anticoagulants (NOACs), which include dabigatran, apixaban, edoxaban and rivaroxaban, are preferred over vitamin K antagonists for stoke prevention in most patients with non-valvular atrial fibrillation. The NOACs are contraindicated in atrial fibrillation patients with rheumatic mitral stenosis or mechanical heart valves. There is evidence that bioprosthetic heart valves are less thrombogenic than mechanical heart valves, but it is unknown whether the risk of thromboembolism in atrial fibrillation patients with bioprosthetic valves differs from that in patients without such valves.

Areas covered: The authors present a review of the efficacy and safety evidence surrounding the use of NOACs for stroke prevention in atrial fibrillation patients with bioprosthetic heart valves.

Expert commentary: While the data is limited, there is no significant difference in thromboembolic, and bleeding outcomes in patients with AF and bioprosthetic heart valves treated with NOAC therapy. Future studies are required before definitive conclusions can be drawn regarding the safety and efficacy of NOAC therapy in AF patients bioprosthetic heart valves.

KEYWORDS:

• Atrial fibrillation
• bioprosthetic heart valves
• stroke
• anticoagulation

Declaration of interest

The Authors have received non-financial support by Bayer Pharma AG for investigator meetings within the context of the Thrombosis Academy for Learning Education and Network Training (TALENT) program. The sponsor had no role in study design, data collection, data analysis, the writing of the manuscript, or the submission process. J Andrade is supported by a Michael Smith Foundation for Health Research Scholar Award and is an investigator with the Cardiac Arrhythmia Network of Canada (CANet), a Networks of Centres of Excellence. JL Weitz holds the Canada Research Chair (Tier I) in Thrombosis and the Heart and Stroke Foundation J.F. Mustard Chair in Cardiovascular Research. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.