Subject(s)
Bioprosthesis , COVID-19 , Heart Valve Prosthesis , Thrombosis , Bioprosthesis/adverse effects , Heart Valve Prosthesis/adverse effects , Humans , Mitral Valve/diagnostic imaging , Mitral Valve/surgery , Prosthesis Failure , SARS-CoV-2 , Thrombolytic Therapy , Thrombosis/drug therapy , Thrombosis/etiologySubject(s)
Aortic Valve Insufficiency/diagnosis , Bioprosthesis/adverse effects , COVID-19 , Heart Valve Prosthesis/adverse effects , SARS-CoV-2 , Transcatheter Aortic Valve Replacement , Aged , Aortic Valve Insufficiency/diagnostic imaging , Aortic Valve Insufficiency/surgery , Echocardiography, Transesophageal , Humans , Male , Prosthesis Failure , Suture TechniquesSubject(s)
Bioprosthesis/virology , COVID-19/complications , Heart Valve Prosthesis/virology , Thrombosis/complications , Aged , Anticoagulants/therapeutic use , Aortic Valve/diagnostic imaging , Echocardiography, Transesophageal/methods , Female , Humans , SARS-CoV-2 , Thrombosis/diagnostic imaging , Thrombosis/drug therapy , Tomography, X-Ray ComputedABSTRACT
There are limited data regarding direct oral anticoagulants (DOACs) for stroke prevention in patients with bioprosthetic heart valves (BHVs) and atrial fibrillation (AF). The objectives of this study were to evaluate the ambulatory utilization of DOACs and to compare the effectiveness and safety of DOACs versus warfarin in patients with AF and BHVs. We conducted a retrospective cohort study at a large integrated health care delivery system in California. Patients with BHVs and AF treated with warfarin, dabigatran, rivaroxaban, or apixaban between September 12, 2011 and June 18, 2020 were identified. Inverse probability of treatment-weighted comparative effectiveness and safety of DOACs compared with warfarin were determined. Use of DOACs gradually increased since 2011, with a significant upward in trend after a stay-at-home order related to COVID-19. Among 2,672 adults with BHVs and AF who met the inclusion criteria, 439 were exposed to a DOAC and 2233 were exposed to warfarin. For the primary effectiveness outcome of ischemic stroke, systemic embolism and transient ischemic attack, no significant association was observed between use of DOACs compared with warfarin (HR 1.19, 95% CI 0.96 to 1.48, pâ¯=â¯0.11). Use of DOACs was associated with lower risk of the primary safety outcome of intracranial hemorrhage, gastrointestinal bleeding, and other bleed (HR 0.69, 95% CI 0.56 to 0.85, p < 0.001). Results were consistent across multiple subgroups in the sensitivity analyses. These findings support the use of DOACs for AF in patients with BHVs.
Subject(s)
Anticoagulants/administration & dosage , Atrial Fibrillation/drug therapy , Bioprosthesis , Heart Valve Diseases/complications , Heart Valves , Stroke/prevention & control , Warfarin/administration & dosage , Administration, Oral , Adolescent , Adult , Aged , Atrial Fibrillation/complications , Female , Heart Valve Diseases/surgery , Humans , Male , Middle Aged , Retrospective Studies , Stroke/etiology , Treatment Outcome , Young AdultABSTRACT
Patients with COVID-19 may present a hypercoagulable state, with an important impact on morbidity and mortality. Because of this situation pulmonary embolism is a frequent complication during the course of infection. We present the case of a patient recently discharged, after admission with confirmed COVID-19, who developed a pulmonary embolism and thrombosis of a biological mitral valve prosthesis, producing valve obstruction and stenosis. After 15 days of anticoagulant treatment, resolution of the thrombus and normalisation of prosthetic valve function was observed. This case supports current recommendations of administering full-dose anticoagulation therapy to COVID-19 patients with biological heart valve prosthesis, even after the acute phase of infection.