Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Efficacy of NOACs in Patients with AF and VHD

J Am Heart Assoc; ePub 2018 Apr 5; Briasoulis, et al

Novel oral non-vitamin K anticoagulants is a safe and effective option for prevention of systemic thromboembolism in older patients with atrial fibrillation (AF) and valvular heart disease (VHD), a recent study found. Medicare beneficiaries enrolled in Medicare Part D benefit plan from 2011 and 2013 with newly diagnosed AF were identified. Primary outcomes of all-cause mortality, ischemic strokes, major bleeding, and myocardial infarction (MI) were compared across 3 anticoagulants. Among the details:

  • 5,871 patients with VHD and 40,221 patients without VHD and AF were studied.
  • Both dabigatran and rivaroxaban were associated with significantly lower risk of death in patients with VHD with AF.
  • Nongastrointestinal bleeding was significantly reduced with dabigatran and rivaroxaban vs warfarin in those with VHD.
  • Ischemic stroke and gastrointestinal bleeding rates did not differ in patients with VHD.
  • The effects of the 3 anticoagulants were comparable in patients with and without VHD and with AF.

Citation:

Briasoulis A, Inampudi C, Akintoye E, Alvarez P, Panaich S, Vaughn-Sarrazin M. Safety and efficacy of novel oral anticoagulants versus warfarin in Medicare beneficiaries with atrial fibrillation and valvular heart disease. [Published online ahead of print April 5, 2018]. J Am Heart Assoc. doi:10.1161/JAHA.118.008773.