PMID- 33744222
OWN - NLM
STAT- MEDLINE
DCOM- 20220121
LR  - 20220121
IS  - 1552-6259 (Electronic)
IS  - 0003-4975 (Linking)
VI  - 113
IP  - 1
DP  - 2022 Jan
TI  - New Oral Anticoagulants Versus Warfarin in Atrial Fibrillation After Early 
      Postoperative Period in Patients With Bioprosthetic Aortic Valve.
PG  - 75-82
LID - S0003-4975(21)00521-X [pii]
LID - 10.1016/j.athoracsur.2021.03.016 [doi]
AB  - BACKGROUND: The efficacy of novel nonvitamin K antagonist oral anticoagulants 
      (NOACs) in nonvalvular atrial fibrillation (AF) to prevent stroke is well 
      assessed, but NOACs use in AF that occurs after bioprosthetic aortic valve 
      replacement (AVR) is not endorsed. This retrospective real-world study evaluated 
      the efficacy and safety of NOACs prescribed no earlier than 4 months after AVR as 
      an alternative to warfarin in patients with AF. METHODS: We pooled 1032 patients 
      from the databases of 5 centers. Ischemic/embolic events and major bleeding rates 
      were compared between 340 patients assuming NOACs and 692 prescribed warfarin. 
      Propensity score matching was performed to avoid the bias between groups. 
      RESULTS: The NOACs vs warfarin embolic/ischemic rate was 13.5% (46 of 340) vs 
      22.7% (157 of 692), respectively, (hazard ratio [HR], 0.5; 95% confidence 
      interval [CI], 0.37-0.75; P < .001), and the incidence rate was 3.7% vs 6.9% 
      patients/year, respectively (log-rank test P = .009). The major bleeding rate was 
      7.3% (25 of 340) vs 13% (90 of 692) (HR, 0.5; 95% CI, 0.33-0.84; P = .007), and 
      the incidence rate was 2% vs 4% patients/year (log-rank test P = .002.) After 
      propensity score matching, the NOACs vs warfarin embolic/ischemic rate was 13.1% 
      (42 of 321) vs 21.8% (70 of 321) (HR, 0.6; 95% CI, 0.4-0.9; P = .02), and the 
      incidence rate was 4.1% vs 6.7% patients/year (log rank test P = .01). The major 
      bleeding rate was 7.8% (25 of /321) vs 13.7% (44 of 321) (HR, 0.5; 95% CI, 
      0.31-0.86; P = .01), and the incidence rate was 2.4% vs 4.2% patients/year 
      (log-rank P = .01). CONCLUSIONS: In a real-word study, NOACs use overcomes the 
      indications provided by guidelines. This study evidenced that NOACs use in 
      patients who developed AF after bioprosthetic AVR was more effective in 
      prevention of thromboembolism and safe in reduction of major bleeding events 
      compared with warfarin.
CI  - Copyright (c) 2022 The Society of Thoracic Surgeons. Published by Elsevier Inc. All 
      rights reserved.
FAU - Mannacio, Vito A
AU  - Mannacio VA
AD  - Department of Cardiac Surgery, University of Naples Federico II, Naples, Italy. 
      Electronic address: vitomannacio2@libero.it.
FAU - Mannacio, Luigi
AU  - Mannacio L
AD  - Department of Cardiac Surgery, University of Naples Federico II, Naples, Italy.
FAU - Antignano, Anita
AU  - Antignano A
AD  - Department of Cardiology, dell'Azienda Ospedaliera di Rilievo Nazionale (AORN) 
      Santobono-Pausillipon, Naples, Italy.
FAU - Mauro, Ciro
AU  - Mauro C
AD  - Department of Cardiology, dell'Azienda Ospedaliera di Rilievo Nazionale (AORN) 
      Cardarelli, Naples, Italy.
FAU - Mastroroberto, Pasquale
AU  - Mastroroberto P
AD  - Department of Cardiac Surgery, University of Catanzaro Magna Graecia, Catanzaro, 
      Italy.
FAU - Musumeci, Francesco
AU  - Musumeci F
AD  - Department of Cardiac Surgery, dell'Azienda Ospedaliera di Rilievo Nazionale 
      (AORN) S. Camillo Forlanini, Rome, Italy.
FAU - Zebele, Carlo
AU  - Zebele C
AD  - Department of Cardiac Surgery Unit, Casa di Cura Montevergine, Mercogliano, 
      Italy.
FAU - Iannelli, Gabriele
AU  - Iannelli G
AD  - Department of Cardiac Surgery, University of Naples Federico II, Naples, Italy.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Multicenter Study
DEP - 20210318
PL  - Netherlands
TA  - Ann Thorac Surg
JT  - The Annals of thoracic surgery
JID - 15030100R
RN  - 0 (Anticoagulants)
SB  - IM
MH  - Administration, Oral
MH  - Aged
MH  - Aged, 80 and over
MH  - Anticoagulants/*therapeutic use
MH  - Aortic Valve/*surgery
MH  - Atrial Fibrillation/*drug therapy
MH  - Bioprosthesis/*adverse effects
MH  - Female
MH  - Heart Valve Prosthesis Implantation/*adverse effects
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Retrospective Studies
EDAT- 2021/03/22 06:00
MHDA- 2022/01/22 06:00
CRDT- 2021/03/21 20:52
PHST- 2020/10/16 00:00 [received]
PHST- 2021/02/05 00:00 [revised]
PHST- 2021/03/01 00:00 [accepted]
PHST- 2021/03/22 06:00 [pubmed]
PHST- 2022/01/22 06:00 [medline]
PHST- 2021/03/21 20:52 [entrez]
AID - S0003-4975(21)00521-X [pii]
AID - 10.1016/j.athoracsur.2021.03.016 [doi]
PST - ppublish
SO  - Ann Thorac Surg. 2022 Jan;113(1):75-82. doi: 10.1016/j.athoracsur.2021.03.016. 
      Epub 2021 Mar 18.