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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
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Revolutionizing anticoagulation: DOAC versus VKA in atrial fibrillation with early post-bioprosthetic valves

Lizhu Han1, Yin Wang1, Hulin Wang1

  • 1Department of Pharmacy, Personalized Drug Research and Therapy Key Laboratory of Sichuan Province, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.

International Journal of Surgery (London, England)
|February 12, 2026
PubMed

Insights

Direct oral anticoagulants (DOACs) are as effective and safe as vitamin K antagonists (VKAs) in patients within 3 months of biological heart valve surgery. This finding suggests DOACs may be a viable alternative for early postoperative anticoagulation in atrial fibrillation patients.

Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Trials

Background:

  • Direct oral anticoagulants (DOACs) are standard for non-valvular atrial fibrillation.
  • Recent guidelines suggest DOACs for atrial fibrillation patients ≥3 months post-bioprosthetic valve replacement.
  • Efficacy and safety of DOACs within 3 months of biological valve surgery remain uncertain.

Purpose of the Study:

  • To systematically review literature on DOACs versus vitamin K antagonists (VKAs) in atrial fibrillation patients early after biological valve surgery.
  • To evaluate the efficacy and safety of DOACs in this specific patient cohort.

Main Methods:

  • Systematic literature search of PubMed, Embase, Web of Science, and Cochrane Library up to August 15, 2025.
  • Included randomized controlled trials (RCTs) comparing DOACs with VKAs.
  • Assessed outcomes: all-cause death, stroke/thromboembolic events, bleeding events, and cardiovascular death.

Main Results:

  • Six RCTs involving 2725 patients (1386 DOACs, 1339 VKAs) were analyzed.
  • No significant differences found between DOACs and VKAs for all-cause death, stroke/thromboembolic events, or major bleeding.
  • Secondary analysis also revealed no significant difference in cardiovascular death.

Conclusions:

  • DOACs demonstrate comparable efficacy and safety to VKAs in the early postoperative period after biological valve replacement or repair.
  • DOACs may serve as an alternative to VKAs for anticoagulation in this patient group.
Abstract

Keywords:
apixabanatrial fibrillationbioprosthetic valvesdirect oral anticoagulants (DOACs)edoxabanvitamin K antagonists (VKAs)warfarin

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