Current Stroke Clinical Outcomes of Direct Anticoagulation Therapy in Patients with Valvular Atrial Fibrillation: A Scoping Review

While direct oral anticoagulants (DOACs) have been proven effective in stroke prevention in patients with non-valvular AF (NVAF), there is limited evidence-based guidance on DOAC use in valvular atrial fibrillation. This scoping review aims to examine clinical cerebrovascular outcomes and safety profiles within valvular AF (VAF) patients treated with DOACs. This scoping review was conducted following the Joanna Briggs Institute methodology for scoping reviews and reported consulting the Preferred Reporting Items for Systematic Review and Meta-Analysis extension for scoping reviews checklist. Pubmed, OVID Medline and Web of Science databases were searched for manuscripts published from inception to July 25, 2022 and included based on pre-registered criteria. Data extraction included patient demographics, valvular disease and Afib classification, DOAC type, cerebro-cardiovascular outcomes variables, and bleeding risks. There were 12 studies with 69,741 VAF patients treated with DOACs. At the 12-month follow-up, acute ischemic stroke and major bleeding events occurred in 3.5% and 5.8% of these patients, respectively. DOACs in VAF were associated with similar clinical cerebrovascular outcomes with decreased risk of fatal bleeding rates when compared to warfarin. More controlled studies are needed to further assess the safety and efficacy of DOACs in this population.