DOACs more effective and safer for patients with AF and various VHD than Warfarin: Study
Researchers have found in a retrospective cohort study that direct oral anticoagulants (DOACs) were associated with lower risks of ischemic stroke, systemic embolism, and bleeding compared to warfarin in patients with atrial fibrillation (AF) and valvular heart disease (VHD). However, the study excluded patients with mechanical heart valves. For those with AF linked to mechanical heart valves or moderate to severe mitral stenosis, warfarin remains the recommended option. DOACs appeared to offer better stroke and thromboembolism prevention while maintaining safety for eligible AF and VHD patients.
Despite proven efficacy and safety of direct oral anticoagulants (DOACs) over warfarin in patients with atrial fibrillation (AF), data on patients with AF and valvular heart disease remain scarce. We aimed to evaluate the DOACs compared with warfarin among patients with AF and valvular heart disease. They conducted a retrospective cohort study of patients ≥18 years of age, who had AF and valvular heart disease, and were new users of DOACs or warfarin. The primary effectiveness outcomes were ischemic stroke or systemic embolism, and bleeding for safety. We used Cox proportional‐hazards regression after propensity score matching to estimate hazard ratios (HRs) and 95% CIs. In the matched cohort, DOAC use (versus warfarin) was associated with a lower rate of ischemic stroke or systemic embolism and bleeding. They found a lower rate of ischemic stroke or systemic embolism with rivaroxaban and apixaban but not dabigatran. They found a lower rate of bleeding with rivaroxaban, apixaban, dabigatran, and edoxaban. They were unable to obtain estimates for the effectiveness outcome with edoxaban due to the small number of events. In this study of patients with AF and valvular heart disease, DOAC treatment was associated with a lower risk of ischemic stroke or systemic embolism and bleeding compared with warfarin.
Reference:
Dawwas, G. K., Lewis, J. D., & Cuker, A. (2025). Direct Oral Anticoagulants Compared With Warfarin in Patients With Atrial Fibrillation and Valvular Heart Disease Without Mechanical Valves. *Journal of the American Heart Association*. [https://doi.org/10.1161/JAHA.124.03547](https://doi.org/10.1161/JAHA.124.03547)
Keywords:
DOACs, effective, safer, patients, AF, various, VHD, Warfarin, Study, Dawwas, G. K., Lewis, J. D., & Cuker, A
