# DOAC's bij AF met kleplijden: JACC-review

*geplaatst 2017-03-21 · Atriumfibrilleren · Journal of the American College of Cardiology · doi 10.1016/j.jacc.2016.12.038 · https://hartvaat.nl/2017/03/21/doac-s-bij-af-met-kleplijden-jacc-review/*

Uitgebreide review in JACC over het gebruik van DOAC's bij AF-patiënten met diverse vormen van kleplijden. Biedt een kader voor de indicatiestelling per kleptype.

## English: Non-Vitamin K Antagonist Oral Anticoagulants in Patients With Atrial Fibrillation and Valvular Heart Disease.

This comprehensive JACC review addressed DOAC use in AF patients with various forms of valvular heart disease, providing a framework for anticoagulant selection across the spectrum from native valve disease to prosthetic valves.

## Abstract (original, from the publication)

BACKGROUND: Valvular heart disease (VHD) and atrial fibrillation (AF) often coexist. Phase III trials comparing non-vitamin K antagonist oral anticoagulants (NOACs) with warfarin excluded patients with moderate/severe mitral stenosis or mechanical heart valves, but variably included patients with other VHD and valve surgeries. OBJECTIVES: This study aimed to determine relative safety and efficacy of NOACs in patients with VHD. METHODS: We performed a meta-analysis of the 4 phase III AF trials of the currently available NOACs versus warfarin in patients with coexisting VHD to assess pooled estimates of relative risk (RR) and 95% confidence intervals (CIs) for stroke/systemic embolic events (SSEE), major bleeding, intracranial hemorrhage (ICH), and all-cause death. RESULTS: Compared with warfarin, the rate of SSEE in patients treated with higher-dose NOACs was lower and consistent among 13,585 patients with (RR: 0.70; 95% CI: 0.58 to 0.86) or 58,098 without VHD (RR: 0.84; 95% CI: 0.75 to 0.95; interaction p = 0.13). Major bleeding in patients on higher-dose NOACs versus warfarin was similar and consistent among patients with (RR: 0.93; 95% CI: 0.68 to 1.27) or without VHD (RR: 0.85; 95% CI: 0.70 to 1.02; interaction p = 0.63 for VHD/no-VHD difference). Intracranial hemorrhage was lower with higher-dose NOACs than with warfarin irrespective of VHD (RR: 0.47; 95% CI: 0.24 to 0.93, and 0.49; 95% CI: 0.41 to 059, respectively; interaction p = 0.91). No protective effect of higher-dose NOACs in preventing all-cause death seemed to be present in patients with VHD versus without VHD (RR:1.01; 95% CI: 0.90 to 1.14 vs. RR: 0.88; 95% CI: 0.82 to 0.94, respectively; interaction p = 0.03). CONCLUSIONS: High-dose NOACs provide overall efficacy and safety similar in AF patients with or without VHD.

Auteurs: Giulia Renda, Fabrizio Ricci, Robert P Giugliano, Raffaele De Caterina

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Bron: Journal of the American College of Cardiology, https://doi.org/10.1016/j.jacc.2016.12.038. Bijgewerkt 2026-07-03T13:25:55Z. Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.