Expert: One percent is ‘very small number’
David J. Cohen, MD, commented on the 1% figure, which was so low that a moderator questioned whether it could be due mostly to coding errors.
“This is a very, very small number so at some level it is reassuring that it is so low in the mechanical valves,” Dr. Cohen said. However, he was more circumspect about the larger number in bioprosthetic valves.
“I have always thought it was a bit strange there was a warning against using them in bioprosthetic valves, especially in the aortic position,” he said.
Dr. David J. Cohen
“The trials that established the benefits of DOACs were all in nonvalvular atrial fibrillation, but this did not mean non–aortic stenosis; it meant non–mitral valvular. There have been articles written about how that has been misinterpreted,” said Dr. Cohen, director of clinical and outcomes research at the Cardiovascular Research Foundation and director of academic affairs at St. Francis Hospital, Roslyn, N.Y.
For his part, Dr. Kalra reported that he does not consider DOACs in patients who have undergone a surgical mechanical valve replacement. For bioprosthetic valves, he “prefers” warfarin over DOACs.
Overall, the evidence from the registry led Dr. Kalra to suggest that physicians should continue to “exercise caution” in using DOACs instead of warfarin after any surgical valve replacement “until randomized clinical trials provide sufficient evidence” to make a judgment about relative efficacy and safety.
Results of the study were published online as a research letter in Jama Network Open after Dr. Kalra’s presentation. Dr. Kalra and Dr. Cohen report no potential conflicts of interest.