Mortality over 5 years for patients taking warfarin increased by regarding a third.
Warfarin showed a rapid decrease in aortic valve and a more pronounced increase in mean transvalvular gradient. Photo: Shutterstock.
Patients with aortic valve disease were normally excluded in trials, which implement Direct Oral Antioxidants (DOAC), thus largely replacing Warfarin and other negative drugs such as
vitamin K (VKA).
The mortality in patients who took warfarin, for periods of 5 years or more, increased approximately a third, compared to those who did not receive Oral Anticoagulants (OAC), in this study observational study, jumped 47% compared to patients taking DOAC.
But they are key to a recent body of evidence that VKAs, compared to DOACs, may worsen the progression of valve calcification and perhaps, in a highly speculative new analysis, also reduce survival.
The new findings come from a decade of data and nearly 2,400 patients with aortic stenosis from mild to moderate, and where approximately 30% of whom received OACs, generally for Atrial Fibrillation (AF).
The results are suggestive, and fit with the preclinical clinical evidence of long-term VKA therapy, which would accelerate the structural and functional progression of aortic valve calcification, aortic stenosis and vascular calcification, say researchers from the American College of Cardiology.
Although it cannot determine cause and effect, “this is the study larger revealing the strong association of warfarin relative to DOAC therapy with more rapid disease progression and worse clinical outcomes in the aortic stenosis mild or moderate,” observe the authors, led by Essa H. Dr. Hariri, of the Cleveland Clinic, speaking of the “increasing evidence of favorable clinical outcomes for DOACs, anticoagulation prescribers should consider these observations in high-risk patients.” risk with aortic stenosis concomitant”.
Some of the results point to residual confounding, despite multivariable adjustment efforts.
“At first glance, the results indicate that warfarin is harmful relative to DOACs,” noted John W. Eikelboom, MD, PhD, Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada, who did not is related to the study. The findings are interesting, “however, they are observational and we should be extremely cautious regarding interpreting them,” he told theheart.org | Cardiology Medscape.
For example, Eikelboom said, the effect of mortality of warfarin, compared to DOACs, was “implausibly large,” as was the almost 40% reduction in aortic valve replacement (AVR) for DOACs, compared to no anticoagulation, “despite that there was evidence of progression of valve disease in the DOAC group.
In fact, there are observational data from other sources that support the results of the study current, he said, “but I think the bigger message is that we need to explore this through randomized comparisons.
The study involved 2,383 patients aged 60 years or older with aortic stenosis mild-to-moderate patients treated between 2008 and 2018 who underwent echocardiography at least twice 2 years apart. Approximately 30% received OACs for atrial fibrillation or venous thromboembolism, approximately 20% died, and 30% underwent AVR for a median of 67 months.
In a propensity-matched comparison of warfarin and DOAC patients, the report notes, the warfarin group showed a numerically more rapid decrease in aortic valve area and a more pronounced increase in mean transvalvular gradient.
consulted source here.
