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Non-vitamin K antagonist oral anticoagulants in patients with valvular heart disease.

Publication ,  Journal Article
Fanaroff, AC; Vora, AN; Lopes, RD
Published in: Eur Heart J Suppl
February 2022

The non-vitamin K antagonist oral anticoagulants (NOACs) dabigatran, rivaroxaban, apixaban, and edoxaban have transformed the management of atrial fibrillation (AF), but are only approved by regulatory authorities for stroke prophylaxis in patients with so-called "non-valvular AF." This terminology has spawned confusion about which patients with valvular heart disease benefit from NOACs and which should be treated with vitamin K antagonists (VKAs) instead. Patients with valvular heart disease other than mechanical prosthetic valves or severe mitral stenosis (including those with bioprosthetic valves) were included in pivotal trials demonstrating the benefit of NOACs over VKAs, and consensus guidelines recommend NOACs over VKAs in these patients. Subsequent devoted randomized controlled trials in patients with AF and bioprosthetic valves, including transcatheter valves, have confirmed the safety of NOACs in this population. In patients with rheumatic mitral stenosis, observational studies indicate that NOACs may be safe and effective, but randomized controlled trials are ongoing. By contrast, a randomized controlled trial showed that dabigatran is harmful in patients with mechanical prosthetic mitral valves; however, these data may not extrapolate to patients with mechanical valve prostheses in other locations or to other NOACs, and randomized controlled trials are ongoing. In this review, we discuss these data in greater depth, and make recommendations for the use of NOACs in patients with valvular heart disease.

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Published In

Eur Heart J Suppl

DOI

ISSN

1520-765X

Publication Date

February 2022

Volume

24

Issue

Suppl A

Start / End Page

A19 / A31

Location

England

Related Subject Headings

  • Cardiovascular System & Hematology
  • 3201 Cardiovascular medicine and haematology
  • 1102 Cardiorespiratory Medicine and Haematology
 

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Fanaroff, A. C., Vora, A. N., & Lopes, R. D. (2022). Non-vitamin K antagonist oral anticoagulants in patients with valvular heart disease. Eur Heart J Suppl, 24(Suppl A), A19–A31. https://doi.org/10.1093/eurheartj/suab151
Fanaroff, Alexander C., Amit N. Vora, and Renato D. Lopes. “Non-vitamin K antagonist oral anticoagulants in patients with valvular heart disease.Eur Heart J Suppl 24, no. Suppl A (February 2022): A19–31. https://doi.org/10.1093/eurheartj/suab151.
Fanaroff AC, Vora AN, Lopes RD. Non-vitamin K antagonist oral anticoagulants in patients with valvular heart disease. Eur Heart J Suppl. 2022 Feb;24(Suppl A):A19–31.
Fanaroff, Alexander C., et al. “Non-vitamin K antagonist oral anticoagulants in patients with valvular heart disease.Eur Heart J Suppl, vol. 24, no. Suppl A, Feb. 2022, pp. A19–31. Pubmed, doi:10.1093/eurheartj/suab151.
Fanaroff AC, Vora AN, Lopes RD. Non-vitamin K antagonist oral anticoagulants in patients with valvular heart disease. Eur Heart J Suppl. 2022 Feb;24(Suppl A):A19–A31.
Journal cover image

Published In

Eur Heart J Suppl

DOI

ISSN

1520-765X

Publication Date

February 2022

Volume

24

Issue

Suppl A

Start / End Page

A19 / A31

Location

England

Related Subject Headings

  • Cardiovascular System & Hematology
  • 3201 Cardiovascular medicine and haematology
  • 1102 Cardiorespiratory Medicine and Haematology