# Warfarine behoudt zijn plek bij mechanische kleppen, APS en linkerventrikel-thrombus

*geplaatst 2026-11-09 · Nierziekte · Cardiology research · doi 10.14740/cr2322 · https://hartvaat.nl/2026/12/01/warfarine-behoudt-zijn-plek-bij-mechanische-kleppen-aps-en-linkerventrikel-throm/*

Deze narratieve review belicht de huidige rol van vitamine-K-antagonisten (VKA's) in de cardiovasculaire praktijk. Hoewel DOAC’s de standaard zijn geworden bij veel vormen van atriumfibrilleren, blijven VKA's de enige optie bij mechanische hartkleppen en worden ze bij triple-positief antifosfolipidensyndroom en reumatische hartziekte nog steeds geadviseerd. Voor linkerventrikel-thrombus en patiënten met nierfalen blijft het bewijs wisselend, waardoor een op de onderliggende pathologie gebaseerde keuze voor anticoagulatie essentieel is. Voor cardiologen en internisten betekent dit dat warfarine niet verouderd is, maar dat de indicatie strikt moet worden afgewogen per klinisch scenario.

## English: Warfarin After Seven Decades: Persistent Value and the Contemporary Role of Vitamin K Antagonism.

This narrative review outlines the contemporary indications for vitamin K antagonists (VKAs) in cardiovascular practice. While DOACs have largely replaced warfarin for atrial fibrillation, VKAs remain mandatory for mechanical heart valves and are still preferred in triple-positive antiphospholipid syndrome and rheumatic heart disease. Evidence for left ventricular thrombus and end-stage renal disease remains mixed, reinforcing a substrate-driven approach to anticoagulation. Clinicians should recognize that warfarin retains a defined, albeit narrower, role in highly thrombogenic states where DOACs have not demonstrated non-inferiority.

## Abstract (original, from the publication)

Warfarin is one of the most enduring drugs in cardiovascular medicine. Although direct oral anticoagulants (DOACs) have transformed anticoagulation, especially in atrial fibrillation (AF) eligible for DOAC therapy, their success cannot be extrapolated to every thrombotic substrate. This review examines the contemporary boundaries of warfarin and vitamin K antagonist (VKA) therapy. Mechanical heart valves remain the clearest setting in which lifelong international normalized ratio (INR)-guided VKA therapy is required; randomized attempts to substitute dabigatran or apixaban have failed. In rheumatic heart disease-associated AF, INVICTUS favored VKA therapy over rivaroxaban, supporting the VKA class rather than warfarin specifically. High-risk thrombotic antiphospholipid syndrome, particularly triple-positive disease, is another VKA-preferred setting. Left ventricular thrombus (LVT) occupies an evolving position in which warfarin remains established, while randomized evidence supports rivaroxaban as a potential alternative in selected acute post-myocardial infarction LVT. Pregnancy with mechanical valves requires dynamic maternal-fetal risk balancing, whereas advanced chronic kidney disease and dialysis represent areas of uncertainty rather than intrinsic indications for warfarin. The global relevance of warfarin also depends on total anticoagulation burden, including INR monitoring, travel, treatment continuity, quality of anticoagulation, and reversal capacity. The persistence of VKA efficacy in selected highly thrombogenic environments raises a biologically plausible hypothesis that broader suppression of vitamin K-dependent factors may matter, but this mechanism is not established by clinical trials. Contemporary anticoagulation should therefore be substrate-centered: VKA therapy remains necessary in some conditions, preferred in others, increasingly replaceable in several, and uncertain in a few.

Auteurs: Weverton Ferreira Leite, Wilma Noia Ribeiro, Rui Manuel Dos Santos Povoa, Dirceu Rodrigues de Almeida, Daniela Fernanda Alli Hemerly, Braulio Luna Filho, Valdir Ambrosio Moises, Jose Antonio Franchini Ramires

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Bron: Cardiology research, https://doi.org/10.14740/cr2322. Bijgewerkt 2026-11-03T01:47:47Z. 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.