Postpartum Direct Oral Anticoagulants or Aspirin in Pregnant Women With Atrial Fibrillation: A Propensity Score-Matched Analysis
Document Type
Conference Proceeding
Publication Date
4-2025
Publication Title
Heart Rhythm
Abstract
Background: The use of antithrombotics in pregnant women with atrial fibrillation (AF) requires careful consideration due to unique physiological changes and varying risks, especially postpartum. Current guidelines regarding the choice of postpartum antithrombotic therapy for this population remain limited. Objective: We aimed to assess the clinical outcomes of different types of antithrombotic use in postpartum period in pregnancies with AF. Methods: We utilized the TriNetX network to identify pregnant women with AF admitted for delivery from 2014 to 2023. Patients were categorized based on the type of postpartum antithrombotics used- direct oral anticoagulants (DOAC) and aspirin groups. Those who received both therapies were excluded. Patients were then followed for one year. Primary outcomes included all-cause mortality, major bleeding, ischemic stroke, ischemic heart disease, and all-cause hospitalization. Further analyses were conducted for three-year (patients from 2014-2021) and five-year follow-up periods (patients from 2014- 2019) to evaluate the same outcomes. Results: After propensity score matching, 332 pregnant women with AF were included, with 166 women in each cohort receiving postpartum DOACs or aspirin. Postpartum DOAC use was associated with significantly lower odds of all-cause hospitalization at 1 year (aOR 0.54, 95% CI 0.35–0.84, P50.01), 3 years (aOR 0.43, 95% CI 0.27–0.69, P,0.01), and 5 years (aOR 0.38, 95% CI 0.22–0.65, P,0.01). However, no significant differences were found between the cohorts regarding all-cause mortality, major bleeding, ischemic stroke, or ischemic heart disease at 1-, 3-, and 5-year follow-ups. Conclusion: DOACs use demonstrated superior outcomes compared to aspirin, with lower odds of all-cause hospitalization in postpartum women with AF. However, no significant differences were observed between the cohorts in terms of all-cause mortality, major bleeding, ischemic stroke, or ischemic heart disease.
Volume
22
Issue
4 Suppl
First Page
S237
Last Page
S238
Recommended Citation
Yeo YH, Vignarajah A, Ong TE, Vigneswaramoorthy N, Mehta N. Postpartum direct oral anticoagulants or aspirin in pregnant women with atrial fibrillation: a propensity score-matched analysis. Heart Rhythm. 2025 Apr;22(4 Suppl):S237-S238. doi:10.1016/j.hrthm.2025.03.499
DOI
10.1016/j.hrthm.2025.03.499
Comments
Heart Rhythm Society Annual Meeting, April 24-27, 2025, San Diego, CA