Chaudhri Moiuz, Al Mahrizi Ahmed D, Faltas Marc, Sakowski Louise, Rajendran Pranesh, Borgmann Jodie, Rapelli Vindhya, Jaffri Zehra, Patel Neil, La Quang, Parikh Shrujal A, Acquah Frederick, Kaunzinger Christian, Mehra Aditya
Internal Medicine, Ocean University Medical Center, Brick Township, USA.
Head of Education, Futures Forward Research Institute, Toms River, USA.
Cureus. 2025 Jun 21;17(6):e86473. doi: 10.7759/cureus.86473. eCollection 2025 Jun.
Valvular atrial fibrillation (VAF) increases the risk of thromboembolic events, which require anticoagulant therapy to prevent stroke. Warfarin has become the standard treatment, yet an increasing number of direct oral anticoagulants (DOACs) are becoming popular; however, their role in treating VAF remains unclear. This systematic review evaluated the safety outcomes and effectiveness of DOACs and warfarin treatment for patients with VAF. A systematic database search was performed according to the PRISMA 2020 guidelines through PubMed, Embase, and the Cochrane Library. The study included adult VAF patients who received DOACs or warfarin. Efficacy outcomes were evaluated. The review process included independent screening of studies by multiple authors, who also extracted the data. Due to significant differences in research approaches and outcome measurements, a qualitative analysis was conducted. A total of 537 records were reviewed; three studies met the inclusion criteria. The safety profiles of DOACs matched or surpassed those of warfarin in terms of major bleeding and intracranial hemorrhage occurrence. The efficacy results showed comparable outcomes, but researchers observed distinct results on the basis of valve type. Although existing evidence does not support the use of DOACs in patients with mechanical valves or severe mitral stenosis, our results suggest that they may be safe and effective alternatives to warfarin. Due to the limited availability of high-quality data, further randomized controlled trials are needed to develop evidence-based anticoagulation strategies.
瓣膜性心房颤动（VAF）会增加血栓栓塞事件的风险，这需要抗凝治疗来预防中风。华法林已成为标准治疗方法，但越来越多的直接口服抗凝剂（DOACs）正变得流行起来；然而，它们在治疗VAF中的作用仍不明确。本系统评价评估了DOACs和华法林治疗VAF患者的安全性结局和有效性。根据PRISMA 2020指南，通过PubMed、Embase和Cochrane图书馆进行了系统的数据库检索。该研究纳入了接受DOACs或华法林治疗的成年VAF患者，并对疗效结局进行了评估。审查过程包括由多位作者独立筛选研究，并提取数据。由于研究方法和结局测量存在显著差异，因此进行了定性分析。共审查了537条记录；三项研究符合纳入标准。在大出血和颅内出血发生率方面，DOACs的安全性与华法林相当或优于华法林。疗效结果显示出相当的结局，但研究人员根据瓣膜类型观察到了不同的结果。尽管现有证据不支持在机械瓣膜或严重二尖瓣狭窄患者中使用DOACs，但我们的结果表明，它们可能是华法林安全有效的替代药物。由于高质量数据有限，需要进一步开展随机对照试验，以制定基于证据的抗凝策略。
