{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T16:16:33Z","timestamp":1777479393237,"version":"3.51.4"},"reference-count":48,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Clin Appl Thromb Hemost"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Replacing bioprosthetic valves is common but can cause coagulation issues. This study assesses the safety and efficacy of Direct oral anticoagulants (DOACs) versus vitamin K antagonists (VKAs) in bioprosthetic valve procedures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>PubMed, Cochrane Central, and ScienceDirect were searched till May 2025. The risk ratios (RRs) were pooled with 95% confidence intervals (CIs) under the random effects model using Review Manager software. The quality assessment was conducted using the Cochrane risk of bias (RoB 2.0) tool.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Eight randomized controlled trials involving 3863 patients were included in the meta-analysis. DOACs were associated with a significant reduction in the risk of stroke or systemic embolism compared with VKAs (RR\u2009=\u20090.48; 95%CI: [0.26, 0.88]; p\u2009=\u2009.02). The rate of major bleeding was similar between the DOACs and VKAs (RR\u2009=\u20090.92; 95%CI: [0.49, 1.72]; p\u2009=\u2009.79). There was no significant difference in the incidence of any stroke between the two groups (RR\u2009=\u20090.65; 95%CI: [0.32, 1.31]; p\u2009=\u2009.23). The occurrence of clinically relevant non-major bleeding (RR\u2009=\u20091.17; 95%CI: [0.97, 1.40]; p\u2009=\u2009.10), all-cause mortality (RR\u2009=\u20090.94; 95%CI: [0.75, 1.17]; p\u2009=\u2009.57), and intracranial hemorrhage (ICH) (RR\u2009=\u20090.71; 95%CI: [0.40, 1.26]; p\u2009=\u2009.25) were comparable between the groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>DOACs seem safe after bioprosthetic valve implantation, lowering the risk of stroke or systemic embolism. However, rates of major bleeding, clinically relevant non-major bleeding, any stroke, ICH, and all-cause mortality were comparable between DOACs and VKAs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10760296251415375","type":"journal-article","created":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T13:41:00Z","timestamp":1769521260000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Comparing the Direct Oral Anticoagulants versus Vitamin K Antagonists in Bioprosthetic Valves: A Systematic Review and Meta-Analysis of Randomized Controlled Trials"],"prefix":"10.1177","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-4521-3256","authenticated-orcid":false,"given":"Muhammad Hassan","family":"Waseem","sequence":"first","affiliation":[{"name":"Allama Iqbal Medical College"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zain ul","family":"Abideen","sequence":"additional","affiliation":[{"name":"King Edward Medical University"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ameer Haider","family":"Cheema","sequence":"additional","affiliation":[{"name":"University of Texas Southwestern"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kanza","family":"Farhan","sequence":"additional","affiliation":[{"name":"Jinnah Sindh Medical University"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hafsa Arshad Azam","family":"Raja","sequence":"additional","affiliation":[{"name":"Rawalpindi Medical University"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Muhammad Zubair","family":"Tahir","sequence":"additional","affiliation":[{"name":"Punjab Medical College"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fahad","family":"Saleem","sequence":"additional","affiliation":[{"name":"Punjab Medical College"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amna","family":"Nadeem","sequence":"additional","affiliation":[{"name":"Punjab Medical College"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2085-8739","authenticated-orcid":false,"given":"Pawan Kumar","family":"Thada","sequence":"additional","affiliation":[{"name":"Sotang Primary Hospital, Solukhumbu, Nepal"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2026,1,27]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.21470\/1678-9741-2018-0374"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1515\/bmt-2012-0148"},{"key":"e_1_3_2_4_2","unstructured":"Bioprosthetic valve thrombosis thromboembolism and obstruction: Management - UpToDate. 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