Further Evidence Against DOAC Use in Patients with Mechanical Aortic Valves

The direct oral anticoagulant (DOAC) apixaban was associated with more thromboembolic events than warfarin in patients with the On-X mechanical aortic valve.

The On-X mechanical aortic prosthesis has design features that may make it less vulnerable to thrombosis than other mechanical valves and can be used with a lower intensity of warfarin anticoagulation. In this manufacturer-funded, multicenter, randomized trial (NCT04142658), patients with this valve received treatment with either standard-dose warfarin (target international normalized ratio [INR] range, 2.0–3.0) or apixaban (5 mg twice daily) at least 3 months after surgery. Most patients (84%) remained on low-dose aspirin throughout the study.

The study was prematurely stopped after enrollment of 863 participants (mean age, 56 years; 24% women) due to a higher rate of thromboembolic events in patients receiving apixaban. During a median fol…

Reviewing Author

Howard C. Herrmann, MD

Disclosures

Consultant/Advisory BoardAffluent Medical; Artedrone; Caranx; Johnson & Johnson; Medtronic; Prolifagen; Wells Fargo

EquityMicrointerventional Devices, Inc.

RoyaltiesUniversity of Pennsylvania

Grant/Research SupportAbbott Vascular; Edwards Lifesciences; Johnson & Johnson; Medtronic

Editorial BoardsCatheterization and Cardiovascular Interventions; Journal of the American College of Cardiology; Circulation: Cardiovascular Interventions; JACC Cardiovascular Interventions; JACC Case Reports; JSCAI

Leadership Positions in Professional SocietiesHeart Valve Collaboratory (Scientific Committee Member, Chair of the Publications Committee)