NOAC vs VKA Use Linked to Lower Mortality in Patients With AF and ACHD

Use of non-vitamin K antagonist oral anticoagulants (NOAC) for preventing stroke in patients with atrial fibrillation (AF) and adult congenital heart disease (ACHD) is associated with a decrease in all-cause mortality compared with vitamin K antagonists (VKA), according to study results presented at Heart Rhythm 2025, held from April 24 to 27, 2025, in San Diego, California.

Investigators evaluated clinical outcomes with NOAC and VKA use for stroke prevention in AF and ACHD using data from the TriNetX database.

Eligible participants had ACHD and initiated oral anticoagulants after AF diagnosis. Propensity score matching was used for patients who used NOAC vs those who used VKA.

Outcomes included survival analysis of major adverse cardiovascular events (MACE), major bleeding events, major thromboembolic events, hospitalization in the intensive care unit (ICU), and all-cause mortality.

The analysis included 66,450 participants, 41,132 in the NOAC group and 25,318 in the VKA group. After propensity score matching, each group had 18,336 patients (mean age, 72 years; 57%-58% men). The 2 groups were well matched for comorbidities and baseline characteristics such as heart failure, ischemic heart disease, diabetes, and bleeding history.

The NOAC group had a significantly increased composite of hemorrhagic and thromboembolic event-free survival (hazard ratio [HR], 0.93; P <.001). Major bleeding (HR, 0.67; P <.001) and intracranial bleeding (HR, 0.66; P <.001) were significantly decreased for the NOAC group.

Major thromboembolic events were significantly reduced for the NOAC group (HR, 0.9; P <.001). In addition, ICU admission (HR, 0.84; P <.001) and all-cause hospitalization (HR, 0.96; P =.023) were decreased in the NOAC group.

The NOAC group had significantly reduced all-cause mortality (HR, 0.65; P <.001). A trend was observed for reduced MACE in the NOAC group (HR, 0.96; P =.052).

This article originally appeared on The Cardiology Advisor