ReviewCureus2025
Efficacy and Safety of Direct-Acting Oral Anticoagulants Versus Warfarin in Patients With Mechanical Valve Replacement.
Review in Cureus, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
2 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
This systematic review and meta-analysis aimed to compare the safety and efficacy of direct-acting oral anticoagulants (DOACs) and warfarin in patients with mechanical heart valves, specifically assessing the risks of ischemic stroke, thromboembolism, and major hemorrhage. We included randomized controlled trials (RCTs) that compared DOACs with warfarin, reporting on ischemic stroke, thromboembolism, and major hemorrhage as outcomes. Studies were excluded if they were observational, lacked relevant data, or did not meet the inclusion criteria specified and were extracted from PubMed, Cochrane Central, ClinicalTrials.gov, and Embase with the last search conducted in January 2025. The Cochrane Risk of Bias tool was used to assess the quality of the included studies. A meta-analysis was conducted using the inverse variance method with a fixed-effect model to pool OR with 95% CI for each outcome. Two studies with a total of 1115 participants were included. The DOAC group showed a significantly higher risk of ischemic stroke (OR: 17.42, P=0.005) and thromboembolism (OR: 3.58, P=0.001) compared to warfarin. No significant difference was found in the risk of major hemorrhage (OR: 0.89, P=0.70). The limitations of this review include the small number of included studies and the substantial heterogeneity in the thromboembolism outcomes (Chi²=0.03). There is also a potential for publication bias, as studies with negative or inconclusive results may be underrepresented. Additionally, inconsistencies in how thromboembolism and hemorrhagic events were defined across studies could have affected the outcome assessments. As a result, this meta-analysis implies that clinicians should exercise caution when prescribing DOACs to high-risk populations. Future studies, particularly larger, high-quality RCTs, are needed to further investigate these findings and to explore specific patient subgroups. No financial support was received for this review. This review was registered with PROSPERO (ID CRD42024625615) on December 12, 2024, prior to study search and data extraction.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.