An Evidence-Based Approach to Anticoagulation Therapy Comparing Direct Oral Anticoagulants and Vitamin K Antagonists in Patients With Atrial Fibrillation and Bioprosthetic Valves: A Systematic Review, Meta-Analysis, and Network Meta-Analysis

Analysis (28 studies; n=74,660) found DOACs, compared to vitamin K antagonists, decreased risk of all-cause bleeding (RR 0.80, 95% CI 0.75-0.85, p>0.00001), stroke and systemic embolization (0.89, 0.80-0.99, p=0.03), and intracranial bleeding outcomes (0.62, 0.45-0.86, p=0.004).

SPS commentary:

There was no difference between DOACs and vitamin K antagonists in terms of gastrointestinal bleeding, major bleeding, thromboembolic events, or all-cause mortality. In addition, the network meta-analysis results did not favour any of the studied interventions over each other.

American Journal of Cardiology