Effectiveness and Safety of Direct Oral Anticoagulants Versus Warfarin in Patients With Valvular Atrial Fibrillation
Authors: Siddharth Shah, Jalaj Garg
Journal: Annals of Internal Medicine (2021)

LettersOctober 2021Effectiveness and Safety of Direct Oral Anticoagulants Versus Warfarin in Patients With Valvular Atrial FibrillationSiddharth Shah, MD, Jalaj Garg, MDSiddharth Shah, MDState University of New York—Upstate Medical Center, Syracuse, New YorkSearch for more papers by this author, Jalaj Garg, MDLoma Linda University Health, Loma Linda, CaliforniaSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L21-0562 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR: Dawwas and colleagues' cohort study (1) included 56 336 propensity score–matched patients with valvular AF and showed that DOACs were associated with a lower risk for ischemic stroke or systemic thromboembolism and major bleeding than warfarin. We found several issues with their study design, execution, and interpretation of the results.The term valvular AF is commonly confused with AF in patients with VHD, which is incorrect. Valvular AF is defined as AF in patients with moderate to severe mitral stenosis or a mechanical heart valve. In contrast, nonvalvular AF is defined as AF in the absence of these ...References1. Dawwas GK, Dietrich E, Cuker A, et al. Effectiveness and safety of direct oral anticoagulants versus warfarin in patients with valvular atrial fibrillation. A population-based cohort study. Ann Intern Med. 2021;174:910-9. [PMID: 33780291] doi:10.7326/M20-6194 LinkGoogle Scholar2. January CT, Wann LS, Calkins H, et al; Writing Group Members. 2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Heart Rhythm. 2019;16:e66-93. [PMID: 30703530] doi:10.1016/j.hrthm.2019.01.024 CrossrefMedlineGoogle Scholar3. Eikelboom JW, Connolly SJ, Brueckmann M, et al; RE-ALIGN Investigators. Dabigatran versus warfarin in patients with mechanical heart valves. N Engl J Med. 2013;369:1206-14. [PMID: 23991661] doi:10.1056/NEJMoa1300615 CrossrefMedlineGoogle Scholar4. Guimarães HP, Lopes RD, de Barros, et al; RIVER Trial Investigators. Rivaroxaban in patients with atrial fibrillation and a bioprosthetic mitral valve. N Engl J Med. 2020;383:2117-26. [PMID: 33196155] doi:10.1056/NEJMoa2029603 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Loma Linda University Health, Loma Linda, CaliforniaState University of New York—Upstate Medical Center, Syracuse, New YorkDisclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L21-0562. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoEffectiveness and Safety of Direct Oral Anticoagulants Versus Warfarin in Patients With Valvular Atrial Fibrillation Ghadeer K. Dawwas , Eric Dietrich , Adam Cuker , Geoffrey D. Barnes , Charles E. Leonard , and James D. Lewis Effectiveness and Safety of Direct Oral Anticoagulants Versus Warfarin in Patients With Valvular Atrial Fibrillation Benjamin A. Rodwin Effectiveness and Safety of Direct Oral Anticoagulants Versus Warfarin in Patients With Valvular Atrial Fibrillation Ishak A. Mansi , Sujata Bhushan , and David E. Albracht Metrics Cited byEfficacy and Safety of Direct Oral Anticoagulants in Stable Coronary Artery Disease and Atrial Fibrillation: A Systematic Review and Network Meta-Analysis October 2021Volume 174, Issue 10Page: 1489-1490 ePublished: 19 October 2021 Issue Published: October 2021 Copyright & PermissionsCopyright © 2021 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...