DOACs in the Anticoagulation of Mechanical Valves: A Systematic Review and Future Perspectives
Valvular heart disease is a common disease often necessitating valve replacement. Mechanical heart valves (MHVs) are often used in younger patients because of their longer durability. Their main disadvantage is the need for lifelong anticoagulation. Warfarin is considered a standard treatment, but i...
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| Format: | Article |
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MDPI AG
2023-07-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/12/15/4984 |
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| author | Tom Langenaeken Arnaud Vanoppen Fien Janssens Loes Tanghe Peter Verbrugghe Filip Rega Bart Meuris |
| author_facet | Tom Langenaeken Arnaud Vanoppen Fien Janssens Loes Tanghe Peter Verbrugghe Filip Rega Bart Meuris |
| author_sort | Tom Langenaeken |
| collection | DOAJ |
| description | Valvular heart disease is a common disease often necessitating valve replacement. Mechanical heart valves (MHVs) are often used in younger patients because of their longer durability. Their main disadvantage is the need for lifelong anticoagulation. Warfarin is considered a standard treatment, but it is far from perfect. Direct oral anticoagulants (DOACs) are a new and more patient-friendly alternative to warfarin when anticoagulation is required, but have not yet been approved for the indication of mechanical valves. Evidence acquisition: A literature search of Pubmed, Embase, Web of Science (Core Collection), and Cochrane Library (from inception to May 2023) was performed using a search string that was well defined and not modified during the study. An extensive overview of the search terms used in each database can be found in the Appendix. Only prospective clinical trials were included in this review. A total of 10 publications were included in this review. Relevance to clinical practice: This systematic review summarizes the different types of DOACs and their possible use in the anticoagulation of mechanical valves. We aim to propose future directions in anticoagulation research for mechanical valves. Conclusions: DOAC use in MHVs has been halted due to the failure of both dabigatran and apixaban in two major clinical trials. However, rivaroxaban was successful in two small clinical trials. Ample research is still needed to explore new valve designs as well as new anticoagulation targets. |
| first_indexed | 2024-03-11T00:24:16Z |
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| id | doaj.art-47b4b6a827454076b0cbc9802d5cd10d |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-11T00:24:16Z |
| publishDate | 2023-07-01 |
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| series | Journal of Clinical Medicine |
| spelling | doaj.art-47b4b6a827454076b0cbc9802d5cd10d2023-11-18T23:07:50ZengMDPI AGJournal of Clinical Medicine2077-03832023-07-011215498410.3390/jcm12154984DOACs in the Anticoagulation of Mechanical Valves: A Systematic Review and Future PerspectivesTom Langenaeken0Arnaud Vanoppen1Fien Janssens2Loes Tanghe3Peter Verbrugghe4Filip Rega5Bart Meuris6Department of Cardiac Surgery, University Hospitals Leuven, Herestraat 49, 3000 Leuven, BelgiumDepartment of Cardiac Surgery, University Hospitals Leuven, Herestraat 49, 3000 Leuven, BelgiumDepartment of Cardiac Surgery, University Hospitals Leuven, Herestraat 49, 3000 Leuven, BelgiumDepartment of Cardiac Surgery, University Hospitals Leuven, Herestraat 49, 3000 Leuven, BelgiumDepartment of Cardiac Surgery, University Hospitals Leuven, Herestraat 49, 3000 Leuven, BelgiumDepartment of Cardiac Surgery, University Hospitals Leuven, Herestraat 49, 3000 Leuven, BelgiumDepartment of Cardiac Surgery, University Hospitals Leuven, Herestraat 49, 3000 Leuven, BelgiumValvular heart disease is a common disease often necessitating valve replacement. Mechanical heart valves (MHVs) are often used in younger patients because of their longer durability. Their main disadvantage is the need for lifelong anticoagulation. Warfarin is considered a standard treatment, but it is far from perfect. Direct oral anticoagulants (DOACs) are a new and more patient-friendly alternative to warfarin when anticoagulation is required, but have not yet been approved for the indication of mechanical valves. Evidence acquisition: A literature search of Pubmed, Embase, Web of Science (Core Collection), and Cochrane Library (from inception to May 2023) was performed using a search string that was well defined and not modified during the study. An extensive overview of the search terms used in each database can be found in the Appendix. Only prospective clinical trials were included in this review. A total of 10 publications were included in this review. Relevance to clinical practice: This systematic review summarizes the different types of DOACs and their possible use in the anticoagulation of mechanical valves. We aim to propose future directions in anticoagulation research for mechanical valves. Conclusions: DOAC use in MHVs has been halted due to the failure of both dabigatran and apixaban in two major clinical trials. However, rivaroxaban was successful in two small clinical trials. Ample research is still needed to explore new valve designs as well as new anticoagulation targets.https://www.mdpi.com/2077-0383/12/15/4984DOACmechanical valveanticoagulationanimal trialshuman trialsmechanical valve thrombosis |
| spellingShingle | Tom Langenaeken Arnaud Vanoppen Fien Janssens Loes Tanghe Peter Verbrugghe Filip Rega Bart Meuris DOACs in the Anticoagulation of Mechanical Valves: A Systematic Review and Future Perspectives Journal of Clinical Medicine DOAC mechanical valve anticoagulation animal trials human trials mechanical valve thrombosis |
| title | DOACs in the Anticoagulation of Mechanical Valves: A Systematic Review and Future Perspectives |
| title_full | DOACs in the Anticoagulation of Mechanical Valves: A Systematic Review and Future Perspectives |
| title_fullStr | DOACs in the Anticoagulation of Mechanical Valves: A Systematic Review and Future Perspectives |
| title_full_unstemmed | DOACs in the Anticoagulation of Mechanical Valves: A Systematic Review and Future Perspectives |
| title_short | DOACs in the Anticoagulation of Mechanical Valves: A Systematic Review and Future Perspectives |
| title_sort | doacs in the anticoagulation of mechanical valves a systematic review and future perspectives |
| topic | DOAC mechanical valve anticoagulation animal trials human trials mechanical valve thrombosis |
| url | https://www.mdpi.com/2077-0383/12/15/4984 |
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