{"id":"5d67c61feeb4","type":"article","url":"https://hartvaat.nl/2019/09/01/oac-bij-af-met-kleplijden-en-bioprothese-overzicht/","title":"OAC bij AF met kleplijden en bioprothese: overzicht","title_en":"Oral anticoagulants in atrial fibrillation with valvular heart disease and bioprosthetic heart valves.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog"],"tags":["anticoagulantia","anticoagulatie-kwetsbare-ouderen"],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2019-314767","source_url":"https://doi.org/10.1136/heartjnl-2019-314767","authors":["Aaqib H Malik","Srikanth Yandrapalli","Wilbert S Aronow","Julio A Panza","Howard A Cooper"],"significance":6,"published":"2019-09-01","source_date":"2019-09-01","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/doacs-overzicht/"],"congress":"","summary_en":"This review summarized the evidence for oral anticoagulant use in AF patients with native valvular heart disease and bioprosthetic valves, guiding DOAC prescription in these common clinical scenarios.","created":"2026-07-03T10:28:07Z","updated":"2026-07-03T13:27:18Z","licence":"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.","body_markdown":"Overzicht van de evidence voor orale anticoagulantia bij AF met kleplijden en bioprothese-hartkleppen.","abstract_original":"OBJECTIVE: Current guidelines endorse the use of non-vitamin K antagonist oral anticoagulants (NOACs) in patients with atrial fibrillation (AF). However, little is known about their safety and efficacy in valvular heart disease (VHD). Similarly, there is a paucity of data regarding NOACs use in patients with a bioprosthetic heart valve (BPHV). We, therefore, performed a network meta-analysis in the subgroups of VHD and meta-analysis in patients with a BPHV. METHODS: PubMed, Cochrane and Embase were searched for randomised controlled trials. Summary effects were estimated by the random-effects model. The outcomes of interest were a stroke or systemic embolisation (SSE), myocardial infarction (MI), all-cause mortality, major adverse cardiac events, major bleeding and intracranial haemorrhage (ICH). RESULTS: In patients with VHD, rivaroxaban was associated with more ICH and major bleeding than other NOACs, while edoxaban 30 mg was associated with least major bleeding. Data combining all NOACs showed a significant reduction in SSE, MI and ICH (0.70, [0.57 to 0.85; p<0.001]; 0.70 [0.50 to 0.99; p<0.002]; and 0.46 [0.24 to 0.86; p<0.01], respectively). Analysis of 280 patients with AF and a BPHV showed similar outcomes with NOACs and warfarin. CONCLUSIONS: NOACs performed better than warfarin for a reduction in SSE, MI and ICH in patients with VHD. Individually NOACs performed similarly to each other except for an increased risk of ICH and major bleeding with rivaroxaban and a reduced risk of major bleeding with edoxaban 30 mg. In patients with a BPHV, results with NOACs seem similar to those with warfarin and this needs to be further explored in larger studies."}