DOACs vs. Warfarin in Patients With Valvular Atrial Fibrilla
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Direct oral anticoagulants (DOACs) are increasingly used in place of warfarin, but evidence about their effectiveness and safety in patients with valvular atrial fibrillation (AF) remains limited.

This study aimed to assess the effectiveness and safety of DOACs compared with warfarin in patients with valvular AF.

The participants were adults with valvular AF who were newly prescribed DOACs or warfarin. The primary effectiveness outcome was a composite of ischemic stroke or systemic embolism. The primary safety outcome was a composite of intracranial or gastrointestinal bleeding.

Results:
-- Among a total of 56336 patients with valvular AF matched on propensity score, use of DOACs (vs. warfarin) was associated with lower risk for ischemic stroke or systemic embolism and major bleeding events.

-- The results for the effectiveness and safety outcomes remained consistent for apixaban and rivaroxaban; with dabigatran, results were consistent for the major bleeding outcome but not for effectiveness.

Conclusively, in this comparative effectiveness study using practice-based claims data, patients with valvular AF who were new users of DOACs had lower risks for ischemic stroke or systemic embolism and major bleeding than new users of warfarin. These data may be used to guide risk–benefit discussions regarding anticoagulant choices for patients with valvular AF.

Source: https://www.acpjournals.org/doi/10.7326/M20-6194
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