Effectiveness and safety of non-vitamin K direct oral anticoagulants in atrial fibrillation patients with bioprosthetic valve.
<h4>Background</h4>Non-vitamin K direct oral anticoagulant (DOAC) is effective for prevention of embolic events in nonvalvular atrial fibrillation (AF) patients. However, the effectiveness and safety of DOAC in AF patients who have bioprosthetic heart valve (BPHV) is largely unknown.<...
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Format: | Article |
Language: | English |
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Public Library of Science (PLoS)
2022-01-01
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Series: | PLoS ONE |
Online Access: | https://doi.org/10.1371/journal.pone.0268113 |
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author | Inki Moon Tae-Hwa Go Jang Young Kim Dae Ryong Kang Suk Ho Sohn Hyun-Jung Lee Jae-Woong Choi Jun-Bean Park Ho-Young Hwang Hyung-Kwan Kim Yong-Jin Kim Kyung-Hwan Kim Seung-Pyo Lee |
author_facet | Inki Moon Tae-Hwa Go Jang Young Kim Dae Ryong Kang Suk Ho Sohn Hyun-Jung Lee Jae-Woong Choi Jun-Bean Park Ho-Young Hwang Hyung-Kwan Kim Yong-Jin Kim Kyung-Hwan Kim Seung-Pyo Lee |
author_sort | Inki Moon |
collection | DOAJ |
description | <h4>Background</h4>Non-vitamin K direct oral anticoagulant (DOAC) is effective for prevention of embolic events in nonvalvular atrial fibrillation (AF) patients. However, the effectiveness and safety of DOAC in AF patients who have bioprosthetic heart valve (BPHV) is largely unknown.<h4>Methods</h4>We retrospectively identified patients with AF and BPHV, using the diagnostic code and medical device and surgery information from the Korean National Health Insurance Service database, between 2013 and 2018. A 1:2 propensity score-matched cohort (n = 724 taking warfarin; n = 362 taking DOAC) was constructed and analyzed for the primary clinical outcome, a composite of ischemic stroke and systemic embolism. Important secondary outcomes included major bleeding, all-cause death, and the net clinical outcome, defined as a composite of all embolic events, major bleeding, and death.<h4>Results</h4>The mean age was 78.9±6.8 years old, and 45% (n = 489) were male. The mean CHA2DS2-VASc score was 4.7±1.4. DOAC was non-inferior to warfarin for preventing ischemic stroke and systemic embolism (hazard ratio [HR] 1.14, 95% confidence interval [CI] 0.56-2.34), major bleeding (HR 0.80, 95% CI 0.32-2.03) and all-cause death (HR 1.09, 95% CI 0.73-1.63). As for the net clinical outcome, DOAC was also similar to warfarin (HR 1.06, 95% CI 0.76-1.47). These outcomes were not different in various subgroups analyzed.<h4>Conclusion</h4>In this nationwide Korean AF population with a BPHV, DOAC was at least as effective and safe as warfarin for the prevention of systemic embolic events. These results suggest that DOAC may be an excellent alternative to warfarin in AF patients with BPHV. |
first_indexed | 2024-12-12T00:45:47Z |
format | Article |
id | doaj.art-3f237c54bf1449cc817a362c87fe8a31 |
institution | Directory Open Access Journal |
issn | 1932-6203 |
language | English |
last_indexed | 2024-12-12T00:45:47Z |
publishDate | 2022-01-01 |
publisher | Public Library of Science (PLoS) |
record_format | Article |
series | PLoS ONE |
spelling | doaj.art-3f237c54bf1449cc817a362c87fe8a312022-12-22T00:44:08ZengPublic Library of Science (PLoS)PLoS ONE1932-62032022-01-01176e026811310.1371/journal.pone.0268113Effectiveness and safety of non-vitamin K direct oral anticoagulants in atrial fibrillation patients with bioprosthetic valve.Inki MoonTae-Hwa GoJang Young KimDae Ryong KangSuk Ho SohnHyun-Jung LeeJae-Woong ChoiJun-Bean ParkHo-Young HwangHyung-Kwan KimYong-Jin KimKyung-Hwan KimSeung-Pyo Lee<h4>Background</h4>Non-vitamin K direct oral anticoagulant (DOAC) is effective for prevention of embolic events in nonvalvular atrial fibrillation (AF) patients. However, the effectiveness and safety of DOAC in AF patients who have bioprosthetic heart valve (BPHV) is largely unknown.<h4>Methods</h4>We retrospectively identified patients with AF and BPHV, using the diagnostic code and medical device and surgery information from the Korean National Health Insurance Service database, between 2013 and 2018. A 1:2 propensity score-matched cohort (n = 724 taking warfarin; n = 362 taking DOAC) was constructed and analyzed for the primary clinical outcome, a composite of ischemic stroke and systemic embolism. Important secondary outcomes included major bleeding, all-cause death, and the net clinical outcome, defined as a composite of all embolic events, major bleeding, and death.<h4>Results</h4>The mean age was 78.9±6.8 years old, and 45% (n = 489) were male. The mean CHA2DS2-VASc score was 4.7±1.4. DOAC was non-inferior to warfarin for preventing ischemic stroke and systemic embolism (hazard ratio [HR] 1.14, 95% confidence interval [CI] 0.56-2.34), major bleeding (HR 0.80, 95% CI 0.32-2.03) and all-cause death (HR 1.09, 95% CI 0.73-1.63). As for the net clinical outcome, DOAC was also similar to warfarin (HR 1.06, 95% CI 0.76-1.47). These outcomes were not different in various subgroups analyzed.<h4>Conclusion</h4>In this nationwide Korean AF population with a BPHV, DOAC was at least as effective and safe as warfarin for the prevention of systemic embolic events. These results suggest that DOAC may be an excellent alternative to warfarin in AF patients with BPHV.https://doi.org/10.1371/journal.pone.0268113 |
spellingShingle | Inki Moon Tae-Hwa Go Jang Young Kim Dae Ryong Kang Suk Ho Sohn Hyun-Jung Lee Jae-Woong Choi Jun-Bean Park Ho-Young Hwang Hyung-Kwan Kim Yong-Jin Kim Kyung-Hwan Kim Seung-Pyo Lee Effectiveness and safety of non-vitamin K direct oral anticoagulants in atrial fibrillation patients with bioprosthetic valve. PLoS ONE |
title | Effectiveness and safety of non-vitamin K direct oral anticoagulants in atrial fibrillation patients with bioprosthetic valve. |
title_full | Effectiveness and safety of non-vitamin K direct oral anticoagulants in atrial fibrillation patients with bioprosthetic valve. |
title_fullStr | Effectiveness and safety of non-vitamin K direct oral anticoagulants in atrial fibrillation patients with bioprosthetic valve. |
title_full_unstemmed | Effectiveness and safety of non-vitamin K direct oral anticoagulants in atrial fibrillation patients with bioprosthetic valve. |
title_short | Effectiveness and safety of non-vitamin K direct oral anticoagulants in atrial fibrillation patients with bioprosthetic valve. |
title_sort | effectiveness and safety of non vitamin k direct oral anticoagulants in atrial fibrillation patients with bioprosthetic valve |
url | https://doi.org/10.1371/journal.pone.0268113 |
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