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Funding Acknowledgements Type of funding sources: None. Background- Bioprosthetic valve (BPV) implantation is preferred over mechanical valves for aortic and mitral valve replacement. BPV can have concurrent atrial fibrillation (AF). Primary advantage of BPV is the limited need of anticoagulation (AC) as compared to mechanical valves. However, recommendations for use of AC in BPV are not clear. Purpose We studied direct oral anticoagulants (DOACs) cardiovascular efficacy and safety in BPV as compared to Vitamin K antagonist (VKA, or warfarin). Methods- Electronic databases (PubMed, Embase, Scopus, Cochrane) were searched from inception to  November 28th, 2020. Using a generic invariance weighted fixed effects model, Hazard ratios (HRs) and their 95% confidence intervals (CIs) from individual studies were converted to Log HRs and corresponding standard errors, which were then pooled. The primary outcome of interest was  stroke or systemic embolisation (SSE), major bleeding and all-cause mortality. Results- A total of four studies with 1386 participants (DOACs n = 723  ; VKA n = 656) were included in analysis. Mean age was 63.7 and 62.4 years in the DOACs and VKA group respectively. Average follow-up period was 1 year and 4 months. DOACs were more efficacious than VKAs in stroke or  thromboembolism prevention (HR 0.43, 95%CI 0.20-0.94; p = 0.03). There was no difference in efficacy of DOACs as compared to VKAs in terms of major bleeding (HR 0.60; 95% CI 0.34-1.39; p = 0.09) and all-cause mortality (HR 0.99; 95%CI 0.57-1.7; p = 0.97) (Figure 1). We had no publication bias in our results (Egger’s regression p &amp;gt; 0.05). Conclusion- DOACs have similar mortality, and major bleeding risks as that of VKA at a benefit of higher stroke/thromboembolism prevention in patients with concurrent BPV and AF. Abstract Figure. A)SSE B)Major Bleeding C)Mortality

european heart journal. acute cardiovascular care

Safety and efficacy of direct oral anticoagulants (DOACs) vs warfarin in patients with concurrent atrial fibrillation and bioprosthetic mitral or aortic valve replacement-a meta analysis