Hypertrophic cardiomyopathy and atrial fibrillation: comparison of nonvitamin K antagonist oral anticoagulants and warfarin

  • Jung H & al.
  • Chest
  • 22 Nov 2018

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • In patients with hypertrophic cardiomyopathy (HCM) and atrial fibrillation (Afib), nonvitamin K antagonist oral anticoagulants (NOACs) were associated with lower risk for all-cause mortality and composite fatal cardiovascular events compared with warfarin.
  • Risk for stroke and major bleeding was similar in patients receiving NOACs and warfarin.

Why this matters

  • NOACs may be an effective alternative to warfarin, but there are limited data to support their use in patients with HCM and Afib.

Study design

  • Warfarin-treated patients with HCM and Afib (n=955) were compared with a 1:2 propensity matched NOAC-treated patients (n = 1504).
  • Primary outcomes: all-cause mortality, ischaemic stroke, major bleeding and acute myocardial infarction (MI).
  • Secondary outcomes: composite of fatal cardiovascular events (fatal ischaemic stroke, bleeding and acute MI).
  • Funding: Ministry of Education, Science and Technology and Health & Welfare.

Key results

  • Warfarin vs NOAC-treated patients did not show any significant difference in the incidence of:
  • ischaemic stroke (aHR, 0.94; P=.672).
  • major bleeding (aHR, 0.97; P=.838).
  • acute MI (aHR, 1.32; P=.263).
  • Compared with warfarin, use of NOACs was significantly associated with lower risk for:
  • all-cause mortality (aHR, 0.43; P<.001 and>
  • composite of fatal cardiovascular events (aHR, 0.39; P=.013).

Limitations

  • Afib types were not defined.
  • >50% NOAC-treated patients received reduced doses of NOACs.

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