Study indicates warfarin may worsen aortic stenosis outcomes

The 5-year mortality for patients on warfarin has increased by about one-third.

Warfarin showed a rapid decrease in the aortic valve and a more pronounced increase in the mean transvalvular gradient. Photo: Shutterstock.

Patients with aortic valve disease were typically excluded from studies implementing Direct Oral Antioxidants (DOAC), largely replacing Warfarin and other negative drugs such as

vitamin K (VKA).

O mortality in patients who took warfarin for periods of 5 years or more increased by approximately one-third compared to those who did not receive Oral Anticoagulants (OAC) in this period. studying observational study, jumped 47% compared to patients using DOAC.

But they are key to a recent body of evidence that VKAs, compared to DOACs, can 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 them received OAC, usually for atrial fibrillation (AF).

The results are suggestive and consistent 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 studying higher, revealing the strong association of warfarin versus DOAC therapy with faster disease progression and worse clinical outcomes in the aortic stenosis mild or moderate,” note the authors, led by Essa H. Dr. Hariri of the Cleveland Clinic, speaking of the “growing evidence of favorable clinical outcomes for DOACs, anticoagulation prescribers should consider these observations in high-risk patients.” . with aortic stenosis concomitant”.

Some of the results point to residual confounding, despite multivariate adjustment efforts.

“At first glance, the results indicate that warfarin is harmful to DOACs,” noted John W. Eikelboom, MD, PhD, Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada, which is not related to studying. The findings are interesting, “however, they are observational and we need to be extremely cautious when interpreting them,” he told | Cardiology Medscape.

For example, said Eikelboom, the effect of mortality of warfarin compared to DOACs was “implausibly large”, as was the nearly 40% reduction in aortic valve replacement (AVR) for DOACs compared to no anticoagulation, “despite evidence of valve disease progression in the DOAC group.

In fact, there are observational data from other sources that support the results of the studying today, he said, “but I think the bigger message is that we need to explore this through random comparisons.

O studying involved 2,383 patients aged 60 years and over with aortic stenosis mild to moderate patients treated between 2008 and 2018 who underwent echocardiography at least twice with an interval of 2 years. Approximately 30% received OCs for atrial fibrillation or venous thromboembolism, approximately 20% died, and 30% underwent AVR for a median of 67 months.

In a propensity comparison of patients on warfarin and DOAC, the report notes, the warfarin group showed a numerically faster decrease in aortic valve area and a more pronounced increase in mean transvalvular gradient.

Source consulted here.


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