Impact of valvular heart disease on oral anticoagulant therapy in non-valvular atrial fibrillation: results from the RAMSES study

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dc.contributor.authorBaşaran, Özcan
dc.contributor.authorDo?an, Volkan
dc.contributor.authorBeton, Osman
dc.contributor.authorTekinalp, Mehmet
dc.contributor.authorAykan, Ahmet Ça?rı
dc.contributor.authorKalaycıoğlu, Ezgi
dc.contributor.authorBolat, İsmail
dc.contributor.authorİnci, Sinan
dc.date.accessioned13.07.201910:50:10
dc.date.accessioned2019-07-16T08:21:43Z
dc.date.available13.07.201910:50:10
dc.date.available2019-07-16T08:21:43Z
dc.date.issued2017
dc.departmentTıp Fakültesi
dc.descriptionPubMed ID: 27848065
dc.description.abstractThe definition of non-valvular atrial fibrillation (NVAF) is controversial. We aimed to assess the impact of valvular heart disease on stroke prevention strategies in NVAF patients. The RAMSES study was a multicenter and cross-sectional study conducted on NVAF patients (ClinicalTrials.gov identifier NCT02344901). The study population was divided into patients with significant valvular disease (SVD) and non-significant valvular disease (NSVD), whether they had at least one moderate valvular disease or not. Patients with a mechanical prosthetic valve and mitral stenosis were excluded. Baseline characteristics and oral anticoagulant (OAC) therapies were compared. In 5987 patients with NVAF, there were 3929 (66%) NSVD and 2058 (34%) SVD patients. The predominant valvular disease was mitral regurgitation (58.1%), followed by aortic regurgitation (24.1%) and aortic stenosis (17.8%). Patients with SVD had higher CHA2DS2VASc [3.0 (2.0; 4.0) vs. 4.0 (2.0; 5.0), p < 0.001] and HAS-BLED [2.0 (1.0; 2.0) vs. 2.0 (1.0; 2.0), p = 0.004] scores compared to patients with NSVD. Overall, 2763 (71.2%) of NSVD and 1515 (73.8%) of SVD patients were on OAC therapy (p = 0.035). When the patients with SVD were analyzed separately, the mean CHA2DS2VASc and HAS-BLED scores were higher in patients with mitral regurgitation compared to patients with aortic regurgitation and aortic stenosis [4.0 (3.0; 5.0), 3.0 (2.0; 4.0), 3.0 (2.0; 4.0) p < 0.001 and 2.0 (1.0; 3.0), 1.0 (1.0; 2.0), 1.0 (0.0; 2.0) p < 0.001, respectively]. In patients with SVD, 65.7% of mitral regurgitation, 82.6% of aortic regurgitation and 88.0% of aortic stenosis patients were on OAC therapy. One out of three NVAF patients had at least one moderate valvular heart disease with the predominance of mitral regurgitation. Patients with SVD were at greater risk of stroke and bleeding compared to patients with NSVD. Although patients with mitral regurgitation should be given more aggressive anticoagulant therapy due to their higher risk of stroke, they are undertreated compared to patients with aortic valve diseases. © 2016, Springer Science+Business Media New York.
dc.identifier.doi10.1007/s11239-016-1445-1
dc.identifier.endpage165en_US
dc.identifier.issn0929-5305
dc.identifier.issue2en_US
dc.identifier.scopusqualityQ1
dc.identifier.startpage157en_US
dc.identifier.urihttps://dx.doi.org/10.1007/s11239-016-1445-1
dc.identifier.urihttps://hdl.handle.net/20.500.12451/2309
dc.identifier.volume43en_US
dc.indekslendigikaynakScopus
dc.indekslendigikaynakPubMed
dc.language.isoen
dc.publisherSpringer New York LLC
dc.relation.ispartofJournal of Thrombosis and Thrombolysis
dc.relation.publicationcategoryMakale - Uluslararası Hakemli Dergi - Kurum Öğretim Elemanı
dc.rightsinfo:eu-repo/semantics/openAccess
dc.subjectAtrial Fibrillation
dc.subjectNon-valvular Atrial Fibrillation
dc.subjectOral Anticoagulant Therapy
dc.subjectValvular Heart Disease
dc.titleImpact of valvular heart disease on oral anticoagulant therapy in non-valvular atrial fibrillation: results from the RAMSES study
dc.typeArticle

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