Semin Thromb Hemost 2018; 44(04): 364-369
DOI: 10.1055/s-0037-1615261
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Nonvitamin K Antagonist Oral Anticoagulants Use in Patients with Atrial Fibrillation and Bioprosthetic Heart Valves/Prior Surgical Valve Repair: A Multicenter Clinical Practice Experience

Vincenzo Russo
1  Chair of Cardiology, University of Campania “Luigi Vanvitelli,” Monaldi Hospital, Naples, Italy
,
Emilio Attena
2  Department of Cardiology, Fatebenefratelli Hospital, Naples, Italy
,
Carmine Mazzone
3  Cardiovascular Centre, Health Authority 1, Trieste, Italy
,
Francesca Esposito
4  Department of Cardiology, San Giovanni di Dio e Ruggi d'Aragona Hospital, Salerno, Italy
,
Valentina Parisi
5  Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
,
Ciro Bancone
6  Cardiac Surgery Unit, Monaldi Hospital, Naples, Italy
,
Anna Rago
1  Chair of Cardiology, University of Campania “Luigi Vanvitelli,” Monaldi Hospital, Naples, Italy
,
Gerardo Nigro
1  Chair of Cardiology, University of Campania “Luigi Vanvitelli,” Monaldi Hospital, Naples, Italy
,
Raffaele Sangiuolo
2  Department of Cardiology, Fatebenefratelli Hospital, Naples, Italy
,
Antonio D' Onofrio
7  Departmental Unit of Electrophysiology, Evaluation and Treatment of Arrhythmias, Monaldi Hospital, Naples, Italy
› Author Affiliations
Further Information

Publication History

Publication Date:
05 January 2018 (online)

Abstract

This is an observational study to investigate the efficacy and safety of nonvitamin K antagonist oral anticoagulants (NOACs) in atrial fibrillation (AF) patients with bioprosthetic valves or prior surgical valve repair in clinical practice. A total of 122 patients (mean age: 74.1 ± 13.2; 54 females) with bioprosthetic heart valve or surgical valve repair and AF treated with NOACs were included in the analysis. The mean CHA2DS2-VASc (Congestive heart failure, Hypertension, Age >75 years, Diabetes mellitus, prior Stroke or transient ischemic attack, Vascular disease) and HAS-BLED (Hypertension, Abnormal renal and liver function, Stroke, Bleeding, Labile INR [international normalized ratio], Elderly, Drugs or alcohol) score values were 3.6 ± 1.2 and 2.6 ± 1.4, respectively. Of the total study population, 28.6% was taking apixaban 5 mg twice daily (BID), 24.5% apixaban 2.5 mg BID, 18% dabigatran 150 mg BID, 13% dabigatran 110 mg BID, 9.8% rivaroxaban 20 mg daily (QD), and 5.7% rivaroxaban 15 mg QD. Also, 92% of the study population previously had warfarin replaced with NOACs due to lack compliance and labile INR control (time in therapeutic range < 60%). NOAC therapy for AF was started on average 934 ± 567 days after bioprosthetic heart valve implantation or surgical repair for an average duration of 835 ± 203 days. The study population included 24 (19.6%) patients with bioprosthetic mitral valve, 52 (43%) patients with bioprosthetic aortic valve, 41 (33.6%) patients with previous surgical mitral repair, 5 (4%) patients with previous surgical aortic repair, and concomitant use of NOACs. All patients were evaluated for thromboembolic events (ischemic stroke, transient ischemic attack, systemic embolism) as well as major bleeding events during the follow-up period. In our study population, we recorded a low mean annual incidence of thromboembolism (0.8%) and major bleeding (1.3%). According to our data, anticoagulation therapy with NOACs seems to be an effective and a safe treatment strategy for nonvalvular AF patients with bioprosthetic valves or prior surgical valve repair.