Efficacy of NOACs in Valvular and Non-Valvular Atrial Fibrillation: A Systematic Review

Abstract

Background and objective: Evaluation of NOACs efficacy, including apixaban, edoxaban, dabigatran, and rivaroxaban, as compared to warfarin in patient role with no valvular AF, including patients at severe risk of bleeding and who received treatment with low doses of NOAC, in terms of safety, such as bleeding risk, and effectiveness, such as the stroke risk or systemic intercalation.

Methods: To find the relevant data on the effects of NOACs in valvular and nonvalvular, a thorough search strategy was performed to search through electronic databases such as PubMed, Cochrane, Google Scholar, Science Direct, and EMBASE. A cumulative of 1728 research papers were retrieved in the search results, which were then examined using the PRISMA principles and the eligibility criteria to find only the most valuable and appropriate research.

Results: Dabigatran, edoxaban, rivaroxaban, and apixaban (NOACs), have revolutionized the treatment of AF though regulatory authorities only permit them for stroke prophylaxis in affected roles with no valvular AF. This terminology has laid confusion around which patient role with the valvular heart-related disease gets an advantage from the NOACs and which ought to be treated with vitamin K antagonist. The essential trials showing the superiority of NOACs to VKAs included individuals with VHD other than MPV and severe mitral stenosis, and consensus recommendations advise NOACs more than VKAs in those individuals. They have dedicated succeeding patient-centered randomized controlled studies. Transcatheter and bioprosthetic valves for those with AF have both attested to the safety and usefulness of NOACs in these people. Observational research papers suggest that NOACs could be safer and more useful in people with rheumatic mitral stenosis.

Conclusions: NOACs lowered the chances of venous thromboembolism, cerebral bleeding, and death while having an equal chance of ischemic stroke and hemorrhaging in patient role with AF and Valvular heart diseases. As a result, NOAC is a powerful and secure substitute for warfarin in these people.