NEW ORAL ANTICOAGULANTS VERSUS WARFARIN IN ATRIAL FIBRILLATION AFTER EARLY POST-OPERATIVE PERIOD IN PATIENTS WITH BIOPROSTHETIC AORTIC VALVE.

Abstract Background The efficacy of novel non–vitamin K antagonist oral anticoagulants (NOACs) in nonvalvular atrial fibrillation (AF) to prevent stroke is well assessed but the use in AF occurred 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 alternative to warfarin in patient with AF. Methods We pooled 1032 patients from databases of five centres. Ischemic/embolic events and major bleeding rates were compared between 340 patients assuming NOACs and 692 warfarin. Propensity score matching was performed to avoid the bias between groups. Results NOACs vs warfarin embolic/ischemic rate was 13.5% (46/340) vs 22.7% (157/692) (HR 0.5; 95% CI, 0.37−0.75; p After Propensity score matching, NOACs vs warfarin embolic/ischemic rate was 13.1% (42/321) vs 21.8% (70/321) (HR 0.6; 95% CI, 0.4−0.9; p=0.02); incidence rates 4.1% vs 6.7% patients/year; log rank test p=0.01. Major bleeding rates was 7.8% (25/321) vs 13.7% (44/321) (HR 0.5; 95% CI, 0.31-0.86; p=0.01), incidence rates 2.4% vs 4.2% patients/year; log-rank p=0.01. Conclusions In real-word, 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 to warfarin.