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Int J Cardiol. 2017 Dec 1;248:232-238. doi: 10.1016/j.ijcard.2017.08.010. Epub 2017 Aug 7.

Direct oral anticoagulants in patients with hypertrophic cardiomyopathy and atrial fibrillation.

Author information

1
Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain; CIBER in Cardiovascular Diseases, Madrid, Spain.
2
Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital General Universitario, Alicante, Spain.
3
Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario y Politécnico La Fe, Valencia, Spain.
4
Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Son Llatzer, Majorca, Spain.
5
Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitari Bellvitge, Barcelona, Spain; Genetics Department, Universidad Autónoma de Barcelona, Barcelona, Spain.
6
CIBER in Cardiovascular Diseases, Madrid, Spain; Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Virgen de la Victoria, IBIMA, Málaga, Spain.
7
Centre for Inherited Cardiovascular Diseases, Department of Cardiology, Biomedicine Institute of Seville (IBiS), Hospital Universitario Virgen del Rocío, Seville, Spain.
8
CIBER in Cardiovascular Diseases, Madrid, Spain; Fundación Novoa Santos, Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain; Inherited Cardiac Diseases Unit, Department of Cardiology, Complexo Hospitalario Universitario de A Coruña, Servizo Galego de Saúde (SERGAS), Universidade da Coruña, A Coruña, Spain.
9
CIBER in Cardiovascular Diseases, Madrid, Spain; Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain.
10
CIBER in Cardiovascular Diseases, Madrid, Spain; Inherited Cardiac Diseases Unit, Department of Cardiology, Complexo Hospitalario Universitario de A Coruña, Servizo Galego de Saúde (SERGAS), Universidade da Coruña, A Coruña, Spain.
11
Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain; CIBER in Cardiovascular Diseases, Madrid, Spain; Myocardial Biology Programme, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Facultad de Ciencias de la Salud, Universidad Francisco de Vitoria, UFV, Edificio E, Ctra, M-515 Pozuelo-Majadahonda Km 1,800, 28223, Pozuelo de Alarcón, Madrid, Spain. Electronic address: pablo.gpavia@salud.madrid.org.

Abstract

BACKGROUND:

Chronic anticoagulation with vitamin K antagonists (VKAs) is recommended in patients with hypertrophic cardiomyopathy (HCM) and atrial fibrillation (AF). Direct oral anticoagulants (NOACs) are an alternative to VKAs but there are limited data to support their use in HCM. We sought to describe the pattern of use, thromboembolic events, bleeding and quality of life in patients with HCM and AF treated with NOACs.

METHODS:

Data from patients treated with NOACs (n=99) and VKA (n=433) at 9 inherited cardiac diseases units were retrospectively collected. Annual rates of embolic events, serious bleeding and death were analysed and compared. Quality of life and treatment satisfaction were evaluated with SF-36 and SAFUCA questionnaires in 80 NOAC-treated and 57 VKA-treated patients.

RESULTS:

After median follow-up of 63 months (IQR: 26-109), thromboembolic events (TIA/stroke and peripheral embolism) occurred in 10% of patients on oral anticoagulation. Major/clinically relevant bleeding occurred in 3.8% and the global mortality rate was 23.3%. Thromboembolic event rate was 0.62 per 100patient-years in the NOAC group vs. 1.59 in the VKA group [subhazard ratio (SHR) 0.32;95%CI:0.04-2.45; p=0.27]. Major/clinically relevant bleeding occurred in 0.62 per 100person-years in the NOAC group vs. 0.60 in the VKA group (SHR 1.28;95%CI 0.18-9.30; p=0.85). Quality of life scores were similar in both groups; however, NOAC-treated patients achieved higher scores in the SAFUCA.

CONCLUSIONS:

HCM patients with AF on NOACs showed similar embolic and bleeding rates to those on VKA. Although quality of life was similar in both groups, the NOAC group reported higher treatment satisfaction.

KEYWORDS:

Anticoagulation; Atrial fibrillation; Hypertrophic cardiomyopathy

PMID:
28811092
DOI:
10.1016/j.ijcard.2017.08.010
[Indexed for MEDLINE]

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