Direct oral anticoagulation in atrial fibrillation and heart valve surgery-a meta-analysis and systematic review.

(3) The major bleeding risk was significantly reduced by DOAC with a clear trend toward fewer hemorrhagic stroke or intracranial bleeding events, as the number of overall bleeding events was unaffected in the relatively small subgroup.

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Comparison with studies not included Early findings concerning the use of DOAC reporting on the efficacy and safety in patients with biological heart valves or prior valve repair showed a low incidence for thromboembolism and major bleeding, 21 and an increasing trend for the off-label use of DOAC in this patient population was detected. 27 The use of the factor Xa inhibitor rivaroxaban in patients after mitral valve repair showed no cerebrovascular events or major bleeding in a one-year follow-up study.

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Rates for intracranial bleeding in patients after biological heart valve replacement with or without mitral valve repair did not differ significantly between DOCA and VKA, but showed a trend toward fewer events in the DOAC groups ( Supplemental material, Figures S7 and S8 ).

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