New Oral Anticoagulants Versus Vitamin K Antagonists in Patients with Left-Sided Bioprosthetic Heart Valves and Atrial Fibrillation: A Systematic Review and Meta-Analysis

Abstract Purposes: The aim of the present meta-analysis is to evaluate the efficacy and safety of NOACs versus VKAs in patients with AF and left-sided BHV.Methods: We review literatures for data from Pubmed, Cochrane, ISI Web of Sciences and Embase comparing NOACs with VKAs among patients with left-sided BHV and AF. The efficacy outcomes of this meta-analysis are stroke and all-causes mortality, while major bleeding and any bleeding, as the safety outcomes, are also analyzed.Results: The analysis includes 13 studies enrolling 28,099 patients with AF and left-sided BHV. There are no differences in the incidence of stroke [Risk Ratio (RR) 0.53; 95% confidence interval (CI) 0.21-1.31], all-cause mortality [RR 0.92; 95% CI 0.71-1.18] and any bleeding [RR 0.82; 95% CI 0.60-1.10], when NOACs significantly reduce the rate of major bleeding by 30% compared with VKAs [RR 0.70; 95% CI 0.56-0.87]. For patients younger than 80 years, NOACs may be more valuable in preventing brain embolism than VKAs [RR 0.55; 95% CI 0.35-0.87]. And NOACs may result in fewer bleeding events in patients without heart failure [RR 0.72; 95% CI 0.67-0.78].Conclusion: In patients with AF and left-sided BHV, NOACs correlate with a similar incidence of stroke, all-cause mortality and any bleeding as compared to VKAs, while may reduce the rate of major bleeding. Overall, there is at least comparable safety and efficacy between the using of NOACs and VKAs in this meta-analysis.