ArticleInternational journal of cardiology. Congenital heart disease2026
Comparative efficacy and safety of direct oral anticoagulants versus warfarin in non-valvular atrial fibrillation patients with adult congenital heart disease. Contemporary real-world propensity-matched retrospective cohort study.
Article in International journal of cardiology. Congenital heart disease, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Adults with congenital heart disease (ACHD) have a rising prevalence of atrial fibrillation/flutter (AF) and elevated thrombotic and bleeding risk. Although direct oral anticoagulants (DOACs) are established in non-ACHD AF, comparative effectiveness in ACHD is not well defined. Methods: In a propensity score-matched retrospective cohort study using the TriNetX database, adults (age Results: After matching, 27,166 patients were included (13,583 per group). DOAC use was associated with lower hazard of net clinical outcome (HR 0.87, 95% CI 0.81-0.93), driven by reduced composite bleeding (HR 0.82, 95% CI 0.75-0.90) and all-cause mortality (HR 0.68, 95% CI 0.64-0.72). Hazard of composite embolic events did not differ (HR 0.94, 95% CI 0.87-1.03). DOACs were associated with lower hazard of systemic arterial embolization (HR 0.62, 95% CI 0.52-0.73), nontraumatic ICH (HR 0.74, 95% CI 0.61-0.90), and gastrointestinal bleeding (HR 0.84, 95% CI 0.76-0.93). No significant differences were observed for cerebral infarction or cardioembolic stroke. Conclusions: In a large propensity-matched cohort of patients with ACHD and AF, DOAC therapy was associated with lower hazard of net clinical outcome, all bleeding events, and all-cause mortality compared with warfarin, without increased embolic risk.
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