J Am Heart Assoc

DOACs outperform warfarin in afib with valvular heart disease

February 20, 2025

Study details: This retrospective cohort study evaluated patients ≥18 years with afib and valvular heart disease, excluding those with mechanical valves. The study compared new users of DOACs (i.e., rivaroxaban, apixaban, dabigatran, and edoxaban) with warfarin users, using Cox proportional-hazards regression after propensity score matching.

Results: DOACs were associated with a significantly lower rate of ischemic stroke or systemic embolism (hazard ratio [HR], 0.70; 95% confidence interval [CI], 0.61-0.81) and bleeding (HR, 0.72; 95% CI, 0.65-0.80) compared with warfarin. Specifically, rivaroxaban (HR, 0.74; 95% CI, 0.62-0.89) and apixaban (HR, 0.62; 95% CI, 0.52-0.74) showed lower rates of ischemic events, while all DOACs, including dabigatran and edoxaban, demonstrated reduced bleeding risks.

Clinical impact: The findings support the preferential use of DOACs over warfarin in patients with afib and valvular heart disease, highlighting their superior safety and efficacy profiles. Clinicians should consider DOACs as first-line anticoagulant therapy in this patient population.

Source:

Dawwas GK, et al. (2025, February 18). J Am Heart Assoc. Direct Oral Anticoagulants Compared With Warfarin in Patients With Atrial Fibrillation and Valvular Heart Disease Without Mechanical Valves. https://pubmed.ncbi.nlm.nih.gov/39950313/