Comparative Efficacy and Safety of Direct Oral Anticoagulants Versus Warfarin in Valvular Atrial Fibrillation: A Systematic Qualitative Review

TL;DR

This review compares the safety and effectiveness of DOACs and warfarin for treating valvular atrial fibrillation, finding DOACs may be a viable alternative in some cases.

Contribution

The study provides a systematic qualitative review of DOACs versus warfarin for valvular atrial fibrillation, highlighting gaps in current evidence.

Findings

DOACs showed safety profiles matching or surpassing warfarin in major bleeding and intracranial hemorrhage.

Efficacy outcomes were comparable, but varied based on valve type.

Current evidence does not support DOACs for mechanical valves or severe mitral stenosis.

Abstract

Valvular atrial fibrillation (VAF) increases the risk of thromboembolic events, which require anticoagulant therapy to prevent stroke. Warfarin has become the standard treatment, yet an increasing number of direct oral anticoagulants (DOACs) are becoming popular; however, their role in treating VAF remains unclear. This systematic review evaluated the safety outcomes and effectiveness of DOACs and warfarin treatment for patients with VAF. A systematic database search was performed according to the PRISMA 2020 guidelines through PubMed, Embase, and the Cochrane Library. The study included adult VAF patients who received DOACs or warfarin. Efficacy outcomes were evaluated. The review process included independent screening of studies by multiple authors, who also extracted the data. Due to significant differences in research approaches and outcome measurements, a qualitative analysis was conducted. A total of 537 records were reviewed; three studies met the inclusion criteria. The safety profiles of DOACs matched or surpassed those of warfarin in terms of major bleeding and intracranial hemorrhage occurrence. The efficacy results showed comparable outcomes, but researchers observed distinct results on the basis of valve type. Although existing evidence does not support the use of DOACs in patients with mechanical valves or severe mitral stenosis, our results suggest that they may be safe and effective alternatives to warfarin. Due to the limited availability of high-quality data, further randomized controlled trials are needed to develop evidence-based anticoagulation strategies.

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