New Oral Anticoagulants vs. Vitamin K Antagonists Among Patients With Cardiac Amyloidosis: Prognostic Impact,Frontiers in Cardiovascular Medicine

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New Oral Anticoagulants vs. Vitamin K Antagonists Among Patients With Cardiac Amyloidosis: Prognostic Impact
Frontiers in Cardiovascular Medicine ( IF 2.8 ) Pub Date : 2021-11-30 , DOI: 10.3389/fcvm.2021.742428
Eve Cariou _{1,

2} , Kevin Sanchis _{1,

2} , Khailène Rguez _{1,

2} , Virginie Blanchard _{1,

2,

3,

4} , Stephanie Cazalbou _{1,

2} , Pauline Fournier _{1,

2} , Antoine Huart ₅ , Murielle Roussel ₆ , Pascal Cintas ₇ , Michel Galinier _{1,

2,

4} , Didier Carrié _{1,

2,

4} , Philippe Maury _{1,

4} , Yoan Lavie-Badie _{1,

2,

3,

4} , Olivier Lairez _{1,

2,

3,

4}

Affiliation

Background: Atrial arrhythmia (AA) is common among patients with cardiac amyloidosis (CA), who have an increased risk of intracardiac thrombus. The aim of this study was to explore the prognostic impact of vitamin K-antagonists (VKA) and direct oral anticoagulants (DOAC) in patients with CA.

Methods and Results: 273 patients with CA and history of AA with long term anticoagulation−69 (25%) light chain amyloidosis (AL), 179 (66%) wild-type transthyretin amyloidosis (ATTRwt) and 25 (9%) variant transthyretin amyloidosis (ATTRv)–were retrospectively included between January 2012 and July 2020. 147 (54%) and 126 (46%) patients received VKA and DOAC, respectively. Patient receiving VKA were more likely to have AL with renal dysfunction, higher NT-proBNP and troponin levels. Patients with ATTRwt were more likely to receive DOAC therapy. There were more bleeding complications among patients with VKA (20 versus 10%; P = 0.013) but no difference for stroke events (4 vs. 2%; P = 0.223), as compared to patients with DOAC. A total of 124 (45%) patients met the primary endpoint of all-cause mortality: 96 (65%) and 28 (22%) among patients with VKAs and DOACs, respectively (P < 0.001). After multivariate analysis including age and renal function, VKA was no longer associated with all-cause mortality.

Conclusion: Among patients with CA and history of AA receiving oral anticoagulant, DOACs appear to be at least as effective and safe as VKAs.

中文翻译：

心脏淀粉样变性患者的新型口服抗凝剂与维生素 K 拮抗剂：预后影响

背景：房性心律失常 (AA) 在心脏淀粉样变性 (CA) 患者中很常见，他们的心内血栓风险增加。本研究的目的是探讨维生素 K 拮抗剂 (VKA) 和直接口服抗凝剂 (DOAC) 对 CA 患者的预后影响。

方法和结果：273 名患有 CA 和 AA 病史的长期抗凝患者-69 (25%) 名轻链淀粉样变性 (AL)、179 (66%) 名野生型甲状腺素运载蛋白淀粉样变性 (ATTRwt) 和 25 (9%) 名变异型甲状腺素运载蛋白淀粉样变性 (ATTRv) – 在 2012 年 1 月至 2020 年 7 月期间被回顾性纳入。分别有 147 (54%) 和 126 (46%) 名患者接受了 VKA 和 DOAC。接受 VKA 的患者更可能患有肾功能不全、NT-proBNP 和肌钙蛋白水平较高的 AL。ATTRwt 患者更有可能接受 DOAC 治疗。VKA 患者的出血并发症更多（20% vs 10%；磷 = 0.013) 但中风事件没有差异（4% 对 2%；磷= 0.223)，与 DOAC 患者相比。共有 124 (45%) 名患者达到全因死亡率的主要终点：VKAs 和 DOACs 患者分别为 96 (65%) 和 28 (22%) 名 (磷< 0.001)。经过包括年龄和肾功能在内的多变量分析，VKA 不再与全因死亡率相关。

结论：在接受口服抗凝剂治疗的 CA 和 AA 病史患者中，DOACs 似乎至少与 VKAs 一样有效和安全。

更新日期：2021-11-30

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