{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T15:34:07Z","timestamp":1753889647441,"version":"3.41.2"},"reference-count":33,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2024,2,6]]},"abstract":"<jats:sec sec-type=\"background\" xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">There are limited data on the efficacy and safety of direct oral anticoagulants (DOACs) in patients with atrial fibrillation with significant tricuspid regurgitation (TR), which can lead to hepatic dysfunction and intestinal malabsorption. We aimed to compare the efficacy and safety of DOACs and warfarin for patients with atrial fibrillation with significant (moderate to severe) TR.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              A total of 1215 patients with significant TR and atrial fibrillation who were treated with warfarin (N=491) or DOACs (N=724) were retrospectively analyzed. The primary outcomes were ischemic stroke, systemic embolic events, and hospitalization for major bleeding. The secondary outcomes were intracranial hemorrhage, hospitalization for gastrointestinal bleeding, all\u2010cause mortality, and a composite outcome. The median follow\u2010up duration was 2.4\u2009years. In the inverse probability treatment weighting\u2013adjusted cohort, DOACs and warfarin had a similar risk for ischemic stroke and systemic embolic events (adjusted hazard ratio [aHR], 0.95 [95% CI, 0.67\u20131.36];\n              <jats:italic>P<\/jats:italic>\n              =0.79) and major bleeding (aHR, 0.78 [95% CI, 0.57\u20131.06];\n              <jats:italic>P<\/jats:italic>\n              =0.11). For the secondary outcomes, relative to warfarin, DOACs had a lower risk of intracranial hemorrhage and the composite outcome, and a comparable risk for gastrointestinal bleeding and all\u2010cause mortality. In the subgroup analysis, the effects of DOACs on ischemic stroke and systemic embolic events were comparable to the effects of\u00a0warfarin, even in patients with inferior vena cava plethora (increased right atrial pressure) or severe TR.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">In this study, relative to warfarin, DOACs demonstrated comparable efficacy for ischemic stroke and systemic embolic events and major bleeding, with a lower intracranial hemorrhage risk in patients with significant TR and atrial fibrillation, indicating their effectiveness and safety.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.123.032272","type":"journal-article","created":{"date-parts":[[2024,1,31]],"date-time":"2024-01-31T11:21:51Z","timestamp":1706700111000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Use of Direct\u2010Acting Oral Anticoagulants in Patients With Atrial Fibrillation and Significant Tricuspid Regurgitation"],"prefix":"10.1161","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2237-5631","authenticated-orcid":false,"given":"Yujin","family":"Yang","sequence":"first","affiliation":[{"name":"Department of Cardiology, Asan Medical Center University of Ulsan College of Medicine Seoul Korea"},{"name":"Department of Cardiology Chungnam National University Hospital, Chungnam National University School of Medicine Daejeon Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-4329-6016","authenticated-orcid":false,"given":"Mijin","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Asan Medical Center University of Ulsan College of Medicine Seoul Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jun","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Asan Medical Center University of Ulsan College of Medicine Seoul Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9867-4991","authenticated-orcid":false,"given":"Min Soo","family":"Cho","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Asan Medical Center University of Ulsan College of Medicine Seoul Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sahmin","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Asan Medical Center University of Ulsan College of Medicine Seoul Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6754-8199","authenticated-orcid":false,"given":"Jong\u2010Min","family":"Song","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Asan Medical Center University of Ulsan College of Medicine Seoul Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8275-4871","authenticated-orcid":false,"given":"Dae\u2010Hee","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Asan Medical Center University of Ulsan College of Medicine Seoul Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2018.06.014"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehw229"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2018.11.034"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cardfail.2008.07.236"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2015.11.030"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2018-313312"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehw008"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1107039"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1009638"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0905561"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1310907"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2016.12.031"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.114.014807"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.115.020950"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehu305"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1378\/chest.09-1584"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1093\/ehjci\/jev014"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehv487"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehv317"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/s0735-1097(88)80011-1"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2010.05.010"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1538-7836.2005.01204.x"},{"key":"e_1_3_2_24_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.emc.2012.06.003"},{"key":"e_1_3_2_25_2","doi-asserted-by":"publisher","DOI":"10.1002\/sim.6607"},{"key":"e_1_3_2_26_2","doi-asserted-by":"publisher","DOI":"10.1002\/sim.3697"},{"key":"e_1_3_2_27_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehaa612"},{"key":"e_1_3_2_28_2","doi-asserted-by":"publisher","DOI":"10.1161\/jaha.117.005835"},{"key":"e_1_3_2_29_2","doi-asserted-by":"publisher","DOI":"10.1161\/circulationaha.116.026793"},{"key":"e_1_3_2_30_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2018.11.051"},{"key":"e_1_3_2_31_2","doi-asserted-by":"publisher","DOI":"10.1177\/00912700022008649"},{"key":"e_1_3_2_32_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/eht246"},{"key":"e_1_3_2_33_2","doi-asserted-by":"publisher","DOI":"10.3988\/jcn.2017.13.3.273"},{"key":"e_1_3_2_34_2","doi-asserted-by":"publisher","DOI":"10.1160\/th11-05-0353"}],"container-title":["Journal of the American Heart Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/JAHA.123.032272","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T12:21:58Z","timestamp":1715602918000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/JAHA.123.032272"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,2,6]]},"references-count":33,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2024,2,6]]}},"alternative-id":["10.1161\/JAHA.123.032272"],"URL":"https:\/\/doi.org\/10.1161\/jaha.123.032272","relation":{},"ISSN":["2047-9980"],"issn-type":[{"type":"electronic","value":"2047-9980"}],"subject":[],"published":{"date-parts":[[2024,2,6]]},"assertion":[{"value":"2023-08-18","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-01-08","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-01-31","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e032272"}}