The PROACT Xa trial evaluated the efficacy and safety of apixaban compared to warfarin for patients with an On-X mechanical aortic valve. Apixaban did not demonstrate noninferiority to warfarin and was associated with a higher incidence of valve thrombosis or valve-related thromboembolic events. As a result, warfarin remains the recommended anticoagulant for patients with an On-X mechanical aortic valve. Ongoing research is necessary to explore new anticoagulants and mechanical heart valves that can provide viable alternatives for patients in need of valve replacement.
Apixaban or Warfarin in Patients with an On-X Mechanical Aortic Valve | NEJM Evidence
