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Thromboembolism and Major Bleeding in Patients with Atrial Fibrillation and EHRA Type 2 Valvular Heart Disease: The

Mahasen Al-Najar1, Mohammed Al-Nusair2, Nasr Alrabadi3

  • 1Department of Radiology, Faculty of Medicine, The University of Jordan, Amman, Jordan.

Vascular Health and Risk Management
|March 27, 2023
PubMed

Insights

Patients with atrial fibrillation and EHRA type 2 valvular heart disease face high risks of thromboembolism and bleeding. Non-VKA oral anticoagulants (NOACs), particularly rivaroxaban, show greater efficacy in preventing clots than VKAs.

Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Medicine

Background:

  • Atrial fibrillation (AF) patients face risks of thromboembolism and bleeding.
  • The Evaluated Heartvalves, Rheumatic or Artificial (EHRA) classification stratifies valvular heart disease (VHD) risk.
  • Oral anticoagulants (OACs) are crucial for AF management.

Purpose of the Study:

  • To assess thromboembolism and major bleeding risks in AF patients based on EHRA classification.
  • To compare the safety and efficacy of Vitamin K antagonists (VKAs) and non-VKA oral anticoagulants (NOACs) in AF patients with and without EHRA type 2 VHD.

Main Methods:

  • The Jordan Atrial Fibrillation (JoFib) study followed 2020 AF patients.
  • Patients were categorized by EHRA type 2 VHD status.
  • Thromboembolic events and major bleeding were recorded at 30, 180, and 365 days.
  • Sub-group analysis compared different OACs within VHD groups.

Main Results:

  • EHRA type 2 VHD patients had higher thromboembolic risk and major bleeding rates compared to non-VHD controls.
  • NOACs demonstrated superior efficacy in preventing thromboembolism versus VKAs and no anticoagulation in EHRA type 2 VHD patients.
  • Rivaroxaban significantly reduced thromboembolic risk in EHRA type 2 VHD patients; apixaban and warfarin did not show significant benefit over no anticoagulation.

Conclusions:

  • AF patients with EHRA type 2 VHD are at significant risk for thromboembolism and major bleeding.
  • NOACs are more effective than VKAs for thromboembolism prevention in this cohort without increasing bleeding risk.
  • Rivaroxaban shows particular efficacy in reducing thromboembolic events for EHRA type 2 VHD patients.
Abstract

Keywords:
EHRA type 2 valvular heart diseaseJordanatrial fibrillationbleedingthromboembolism

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