March 31, 2021
Helping to fill an evidence gap, a retrospective review of a large database of US commercial health claims indicates that in patients with valvular atrial fibrillation (AF), direct oral anticoagulants (DOACs) are associated with lower risks of stroke, systemic embolism, and major bleeding compared with warfarin.
The findings shed light on a topic that has proved confusing for clinicians due to the different definitions of “valvular heart disease” used across clinical trials and guidelines. Patients with both AF and valve disease were excluded from the randomized trials that led to the approval of apixaban (Eliquis; Bristol-Myers Squibb), edoxaban (Savaysa; Daiichi-Sankyo), rivaroxaban (Xarelto; Bayer/Janssen), and dabigatran (Pradaxa; Boehringer Ingelheim) in the United States, so their safety and efficacy in this setting remains unclear.