Effectiveness and Safety of NOAC Versus Warfarin in Patients With Atrial Fibrillation and Aortic Stenosis

Melgaard, Line; Overvad, Thure Filskov; Jensen, Mogens Krogh; Christensen, Thomas; Lip, Gregory Y.H.; Larsen, Torben Bjerregaard; Nielsen, Peter Brønnum

doi:10.1161/jaha.121.022628

Cited by 9 publications

(25 citation statements)

References 51 publications

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“…For our case, the rhythm at the time of follow-up (at six months) was restored into a normal sinus rhythm which contributed to improved cardiovascular outcomes in this patient [41,42]. None-vitamin K Oral Anti-Coagulant (Rivaroxaban) was used to prevent stroke in our case; although, this patient needed a long-term follow-up but at the six-month follow-up, there was no incidence of stroke or transient ischemic attack reported, the use of anti-coagulant in AFib is indicated to prevent cardio-embolic stroke if the patient has mitral regurgitation and aortic stenosis or regurgitation [43] The Cardiovascular (CV) outcomes in our cases were improved when ARNI and SGLT2 inhibitors were initiated, but after initiation of ARNI, there was no HF hospitalization [44]. CV Death was not reported during follow-up time.All patients achieved good CV outcomes, and the combination of ARNI and SGLT2I did not harm the patients but reduced morbidity and mortality [45,46].The patients in this case reported were either attended at St. Francis Referral Hospital (SFRH) or Good Samaritan Cancer Hospital (GSCH).…”

Section: Discussionmentioning

confidence: 75%

Theuse of LCZ-696(Sacubitril/Valsartan) and SGLT2inhibitors: A Real World Experience in a Rural African Patient with Heart Failure with Reduced Ejection Fraction (HFrEF). A Case Series

Raphael¹,

Makuka²,

Mogella³

et al. 2023

GJMR

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Objective: To observe the outcomes of the use of both Angiotensin Receptor-Neprilysin inhibitor (ARNI) and sodium-glucose cotransport 2-inhibitor (SGLT2Ii) in terms of echocardiographic parameters, clinical symptoms, cardiovascular death, and Heart failure hospitalization in patient with heart failure reduced ejection fraction (HFrEF) in the hard-to-reach rural area of Africa. Background: Angiotensin Receptor-Neprilysin inhibitor (ARNI) is preferred over angiotensin-converting enzymes inhibitor or an angiotensin II receptor blocker as foundation therapy for patients with heart failure with reduced ejection fraction to reduce the risk of cardiovascular death, Heart failure hospitalization, and Heart failure symptoms. SGLT2 inhibitor (Dapagliflozin and Empagliflozin) is among the four foundation drugs in managing HFrEF.

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Section: Discussionmentioning

confidence: 75%

Theuse of LCZ-696(Sacubitril/Valsartan) and SGLT2inhibitors: A Real World Experience in a Rural African Patient with Heart Failure with Reduced Ejection Fraction (HFrEF). A Case Series

Raphael¹,

Makuka²,

Mogella³

et al. 2023

GJMR

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“…The Danish observational study by Melgaard et al ( 30 ) included 3,726 patients with AF and AS who had been prescribed for either a DOAC ( n = 2,357) or warfarin ( n = 1,369). During a median follow-up 14 months, the adjusted hazard ratio for thromboembolism was 1.62 (95% CI, 1.08–2.45) for DOACs compared with warfarin.…”

Section: Methods and Resultsmentioning

confidence: 99%

“…Both the observational study by Kim et al and the pilot RCT have reported non-inferior efficacy of DOACs compared to warfarin. The observational study conducted by Melgaard et al ( 30 ), however, reported that DOACs are associated with higher rate of thromboembolism than warfarin. The two observational studies were subject to a variety of bias due to their retrospective nature.…”

Section: Discussionmentioning

confidence: 98%

“…In another observational study conducted in 2021, Melgaard et al ( 30 ) collected data from Danish nationwide registries between 2013 and 2018 with the intent to compare effectiveness and safety of DOACs with warfarin in patients with AF and AS. Similar to the situation regarding treatment for patients with both AF and MS, there is lack of information and update about the guidelines on the usage of DOACs for patients carrying AF and AS.…”

Section: Discussionmentioning

confidence: 99%

“…As far, there are four studies completed to explore the efficacy of DOACs in treating patients with AF and MS or AS. The two observational studies, one conducted in Korean ( 33 ) and the other one in Denmark ( 30 ), looked at the effect of DOACs in reducing thromboembolic events in patients with AF and MS or AS, respectively. The RISE-MS is a pilot RCT ( 29 ) to compare rivaroxaban to warfarin about their ability to lower risk of thromboembolism in patients with both AF and MS. DAVID-MS is a registered RCT to compare dabigatran to warfarin for the same indication above.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Effect of direct oral anticoagulants in patients with atrial fibrillation with mitral or aortic stenosis: A review

Guo

Liang

Guan

et al. 2022

Front. Cardiovasc. Med.

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BackgroundSeveral studies have summarized the clinical performance of direct oral anticoagulants (DOACs) in atrial fibrillation (AF) patients with mitral stenosis or aortic stenosis. The significance of this review was to provide clinicians the latest update of the clinical application of DOACs in managing this specific population.MethodsLiteratures from the PubMed database up to July 2022 were screened for inclusion. Studies on the effect of DOACs in patients suffering from AF with mitral or aortic stenosis were assessed for further selection.ResultsResults from four studies were gathered: the RISE MS trial, the DAVID-MS study, and two observational studies. In the Korean observational study with a 27-month follow-up duration and a sample population consisted of patients with mitral stenosis and AF, the thromboembolic events happened at a rate of 2.22%/ year in the DOAC group and 4.19%/year in the warfarin group (adjusted hazard ratio: 0.28; 95% CI: 0.18–0.45). Intracranial hemorrhage occurred at rates of 0.49% and 0.93% in the DOAC and the warfarin groups, respectively (adjusted hazard ratio: 0.53; 95% CI: 0.22–1.26). In the Danish observational study, which had a sample pool with AF patients with aortic stenosis, reported that the adjusted hazard ratios for thromboembolism and major bleeding were 1.62 (95% CI, 1.08–2.45) and 0.73 (95% CI, 0.59–0.91) for DOACs compared with warfarin during 3 years of follow-up. In the RISE-MS trial involving AF patients with mitral stenosis, there were no differences in ischemic stroke, systemic embolic events, or major bleeding between the rivaroxaban vs. warfarin groups during a 1-year follow-up as well as equal rate of increased thrombogenicity in the left atrial appendage at 6 months. The rate of silent cerebral ischemia at 12 months was higher in the warfarin group (17.6%) than that in the rivaroxaban group (13.3%).ConclusionsCurrent published studies supported DOACs' effectiveness in preventing thromboembolism in patients of AF with mitral or aortic stenosis. Further clinical trials could confirm these findings.

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Reporting of Observational Studies Explicitly Aiming to Emulate Randomized Trials

Hansford,

Cashin,

Jones

et al. 2023

JAMA Netw Open

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ImportanceObservational (nonexperimental) studies that aim to emulate a randomized trial (ie, the target trial) are increasingly informing medical and policy decision-making, but it is unclear how these studies are reported in the literature. Consistent reporting is essential for quality appraisal, evidence synthesis, and translation of evidence to policy and practice.ObjectiveTo assess the reporting of observational studies that explicitly aimed to emulate a target trial.Evidence ReviewWe searched Medline, Embase, PsycINFO, and Web of Science for observational studies published between March 2012 and October 2022 that explicitly aimed to emulate a target trial of a health or medical intervention. Two reviewers double-screened and -extracted data on study characteristics, key predefined components of the target trial protocol and its emulation (eligibility criteria, treatment strategies, treatment assignment, outcome[s], follow-up, causal contrast[s], and analysis plan), and other items related to the target trial emulation.FindingsA total of 200 studies that explicitly aimed to emulate a target trial were included. These studies included 26 subfields of medicine, and 168 (84%) were published from January 2020 to October 2022. The aim to emulate a target trial was explicit in 70 study titles (35%). Forty-three studies (22%) reported use of a published reporting guideline (eg, Strengthening the Reporting of Observational Studies in Epidemiology). Eighty-five studies (43%) did not describe all key items of how the target trial was emulated and 113 (57%) did not describe the protocol of the target trial and its emulation.Conclusion and RelevanceIn this systematic review of 200 studies that explicitly aimed to emulate a target trial, reporting of how the target trial was emulated was inconsistent. A reporting guideline for studies explicitly aiming to emulate a target trial may improve the reporting of the target trial protocols and other aspects of these emulation attempts.

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Effectiveness and Safety of NOAC Versus Warfarin in Patients With Atrial Fibrillation and Aortic Stenosis

Cited by 9 publications

References 51 publications

Theuse of LCZ-696(Sacubitril/Valsartan) and SGLT2inhibitors: A Real World Experience in a Rural African Patient with Heart Failure with Reduced Ejection Fraction (HFrEF). A Case Series

Theuse of LCZ-696(Sacubitril/Valsartan) and SGLT2inhibitors: A Real World Experience in a Rural African Patient with Heart Failure with Reduced Ejection Fraction (HFrEF). A Case Series

Effect of direct oral anticoagulants in patients with atrial fibrillation with mitral or aortic stenosis: A review

Reporting of Observational Studies Explicitly Aiming to Emulate Randomized Trials

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