Effectiveness and safety of non-vitamin K antagonist oral anticoagulants in patients with hypertrophic cardiomyopathy with non-valvular atrial fibrillation
Effectiveness and safety of non-vitamin K antagonist oral anticoagulants in patients with hypertrophic cardiomyopathy with non-valvular atrial fibrillation
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DOI：
10.1007/s00380-022-02021-2
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发表时间：
2022-01-18
影响因子：
1.5
通讯作者：
Peng，Feng
中科院分区：
文献类型：
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作者：
Lin，Yunchai;Xiong，Hongping;Peng，Feng
肥厚型心肌病（HCM）合并非瓣膜性房颤（AF）患者发生血栓栓塞事件的风险增加。维生素K拮抗剂（VKA）被推荐作为治疗，但关于处方非维生素K拮抗剂口服抗凝剂（NOAC）的疗效数据仍然有限。这项回顾性研究调查了NOAC给药在HCM和AF患者中的有效性和安全性。在2015年1月至2019年12月期间，共招募了124例接受口服抗凝剂治疗的HCM和AF患者;这些患者随访至2020年3月31日。Kaplan-Meier分析用于比较NOAC与华法林治疗患者的临床结局。使用考克斯模型估计临床相关出血的风险。我们的研究纳入了124例患者，其中48例（38.7%）接受华法林治疗，76例（61.3%）接受NOAC治疗。生存分析显示，在53.6个月的时间内，接受NOAC的患者发生临床相关出血的风险较低（对数秩P = 0.039）。治疗范围内的中位时间（TTR）评分为50%（四分位距：40.43 - 57.08%）。共有9例患者（18.75%）的TTR良好，中位评分为66.35%（四分位距：64.58 - 77.75%）。NOAC和华法林治疗患者的全因死亡、心血管死亡和血栓栓塞发生率相似（分别为log-rankP= 0.239、log-rankP= 0.386和log-rankP= 0.257）。接受NOAC治疗的患者显示临床（P= 0.011）和胃肠道出血（P= 0.032）风险显著降低。考克斯多元回归分析显示，年龄（HR 1.13，95% CI 1.03-1.24;P= 0.013）和华法林治疗（HR 7.37，95% CI 1.63 - 33.36;P= 0.010）是临床相关出血的独立预测因素。与华法林相比，NOAC与HCM伴AF患者的临床相关出血发生率较低相关，如所有原因死亡、心血管死亡和血栓栓塞事件的发生率相似所证明。
Hypertrophic cardiomyopathy (HCM) patients with nonvalvular atrial fibrillation (AF) have an increased risk of suffering thromboembolic events. Vitamin K antagonists (VKA) are recommended as therapy but there is still limited data regarding the efficacy of prescribing non-vitamin K antagonist oral anticoagulants (NOACs). This retrospective study investigates the effectiveness and safety of NOAC administration in patients with HCM and AF. A total of 124 patients with HCM and AF on an oral anticoagulant therapy were recruited between January 2015 and December 2019; these patients were followed up until March 31, 2020. Kaplan–Meier analysis was used to compare the clinical outcomes in patients treated with NOACs versus warfarin. The Cox model was used to estimate the risk of clinically relevant bleeding. Our study included 124 patients, of which 48 (38.7%) received warfarin and 76 (61.3%) received NOACs. Survival analysis showed the patients undergoing NOACs had a lower risk of clinically relevant bleeding (log-rankP= 0.039) over a period of 53.6 months. The median time in therapeutic range (TTR) score was 50% (interquartile range: 40.43 to 57.08%). A total of nine patients (18.75%) had a good TTR with a median score of 66.35% (interquartile range: 64.58 to 77.75%). The incidence of death by all causes, cardiovascular death and thromboembolism were similar between NOAC and warfarin-treated patients (log-rankP= 0.239, log-rankP= 0.386, and log-rankP= 0.257, respectively). Patients treated with NOACs showed a significant reduction in the risk of clinical (P= 0.011) and gastrointestinal bleeding (P= 0.032). Cox multiple regression analysis showed age (HR 1.13, 95% CI 1.03–1.24;P= 0.013) and warfarin therapy (HR 7.37, 95% CI 1.63‐33.36;P= 0.010) were independent predictors of clinically relevant bleeding. Compared to warfarin, NOACs were associated with a lower incidence of clinically relevant bleeding in HCM patients with AF, as demonstrated by the similar incidence of death by all causes, cardiovascular death and thromboembolic events.