Non-vitamin K antagonist oral anticoagulation agents in anticoagulant naive atrial fibrillation patients: Danish nationwide descriptive data 2011-2013

Abstract Objective Possible antithrombotic effect of anticoagulants in coronary artery disease have been proposed but mechanism are poorly understood. Experimental and clinical data indicate a key role of coagulation factors in the progression of atherosclerosis. We sought to evaluate the effect of different oral anticoagulation agents on the progression of atherosclerosis. Methods This retrospective matched case controlled study included patients with atrial fibrillation (AF) who underwent repeated CT angiography for ablation planning. Patients with known structural cardiac pathologies or significant comorbidities were excluded. Patients were stratified according to their anticoagulation into 3 groups: vitamin K antagonist (VKA), direct oral anticoagulation (DOAC) and control (CR; aspirin or no therapy) with equal distribution of age and cardiovascular risk factors. Baseline and follow-up CT exams for repeated AF ablations were evaluated for the CAD profile and (semi)automated quantitative plaque analysis. Results One-hundred sixty-one patients were included (mean CT time interval: 31 months). The three cohorts did not differ in patient characteristics or CT findings at baseline. Absolute plaque volume progression was significantly higher in patients using VKA (66.5±136.7 mm3) compared to both CR (27.2±73.6 mm3) and DOAC (−7.1±42.1 mm3, p<0.001), translating into an annual change of 23.2±47.0 mm3 for VKA, 12.3±4.3 mm3 for CR and −4.6±22.9 mm3 for DOAC (p=0.003). The number of affected segments (SIS) increased by 1.2±1.3 compared to 0.6±1.3 in the control group and 0.2±0.7 in the DOAC group (p<0.0001). Baseline CTA findings Control (n=61) DOAC (n=50) VKA (n=50) p Vessel Volume (mm3) 26.9±42.9 23.1±43.3 27.9±40.7 0.85 Lumen Volume (mm3) 15.7±24.8 13.3±25.1 16.6±27.0 0.82 Coronary Calcium Score (AU) 63.4±187.2 42.0±114.6 53.8±118.6 0.75 Segment Involvement Score 1.8±2.1 1.8±2.3 1.9±2.2 0.96 Stenosis Average Area (%) 19.0±21.7 0.5±0.7 0.5±0.7 0.71 Maximal Plaque Thickness (mm3) 0.5±0.7 0.5±0.7 0.5±0.7 0.69 Total Plaque Volume (mm3) 33.6±60.0 30.0±55.6 34.2±48.0 0.92 AU, Agatston units; DOAC, direct oral anticoagulation; SIS, segment involvement score; VKA, vitamin K antagonist. Changes between baseline and follow-up Conclusion In serial coronary CTs, patients using vitamin K antagonists showed the highest plaque volume progression while patients using a direct oral anticoagulant showed a regression of total plaque volume. Therefore, direct anticoagulation may have a beneficial effect on atherosclerosis.

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Factors associated with silent cerebral events during catheter ablation for atrial fibrillation in the era of uninterrupted oral anticoagulation therapy

European Heart Journal ◽

10.1093/ehjci/ehaa946.0577 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

M Harada ◽

Y Nomura ◽

A Nishimura ◽

Y Motoike ◽

M Koshikawa ◽

...

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Vitamin K ◽

Oral Anticoagulation ◽

Brain Mri ◽

Anticoagulation Therapy ◽

Surrogate Marker ◽

Brain Magnetic Resonance Imaging ◽

Vitamin K Antagonist ◽

Factors Associated

Abstract Background A silent cerebral event (SCE), detected by brain magnetic resonance imaging (MRI), is defined as an acute new brain lesion without clinically apparent neurological deficit, and is frequently observed after catheter ablation in atrial fibrillation (AF) patients. Although the small number of SCEs does not cause neurocognitive dysfunction, the greater volume and/or larger number of SCE lesions are reportedly related to neuropsychological decline; SCE incidence may be a surrogate marker for the potential thromboembolic risk. Thus, strategies to reduce SCEs would be beneficial. Uninterrupted oral anticoagulation strategy for peri-procedural period reportedly reduced the risk of SCEs, but the incidence hovers at 10% to 30%. We sought factors associated with SCEs during catheter ablation for AF in patients with peri-procedural uninterrupted oral anticoagulation (OAC) therapy. Methods AF patients undergoing catheter ablation were eligible (n=255). All patients took non-vitamin K antagonist oral anticoagulants (NOACs) or vitamin K antagonist (VKA) for peri-procedural OAC (>4 weeks) without interruption during the procedure. Brain MRI was performed within 2 days after the procedure to detect SCEs. Clinical characteristics and procedure-related parameters were compared between patients with and without SCEs. Results SCEs were detected in 59 patients (23%, SCE[+]) but not in 196 patients (77%, SCE[-]). Average age was higher in SCE[+] than SCE[-] (66±10 years vs. 62±12 years, p<0.05). Persistent AF prevalence, CHADS2/CHA2DS2-VASc scores, and serum NT-ProBNP levels increased in SCE[+] vs. SCE[-]. In transthoracic/transesophageal echocardiography, left-atrial dimension (LAD) was larger and AF rhythm/spontaneous echo contrast were more frequently observed in SCE[+] than SCE[-]. SCE[+] had lower initial activated clotting time (ACT) before unfractionated heparin (UFH) injection and longer time to reach optimal ACT (>300 sec) before trans-septal puncture than SCE [-]. In multivariate analysis, LAD, initial ACT before UFH injection, and time to reach optimal ACT were predictors for SCEs. Conclusions LAD and intra-procedural ACT kinetics affect SCEs during the procedure in patients with uninterrupted OAC for AF ablation. Shortening time to achieve optimal ACT during the procedure may reduce the risk of SCEs. Funding Acknowledgement Type of funding source: None

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Non-vitamin K antagonist oral anticoagulation usage according to age among patients with atrial fibrillation: Temporal trends 2011–2015 in Denmark

Scientific Reports ◽

10.1038/srep31477 ◽

2016 ◽

Vol 6 (1) ◽

Cited By ~ 57

Author(s):

Laila Staerk ◽

Emil Loldrup Fosbøl ◽

Kasper Gadsbøll ◽

Caroline Sindet-Pedersen ◽

Jannik Langtved Pallisgaard ◽

...

Keyword(s):

Atrial Fibrillation ◽

Vitamin K ◽

Oral Anticoagulation ◽

Temporal Trends ◽

Vitamin K Antagonist

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Quality of vitamin K antagonist oral anticoagulation in 322 patients with atrial fibrillation – real-life data from a survey in Eastern Switzerland

Swiss Medical Weekly ◽

10.4414/smw.2017.14503 ◽

2017 ◽

Vol 147 (3940) ◽

Keyword(s):

Atrial Fibrillation ◽

Vitamin K ◽

Oral Anticoagulation ◽

Real Life ◽

Vitamin K Antagonist ◽

Life Data ◽

Real Life Data

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Antithrombotic Therapy in Patients With Atrial Fibrillation Treated With Oral Anticoagulation Undergoing Percutaneous Coronary Intervention

Circulation ◽

10.1161/circulationaha.118.034722 ◽

2018 ◽

Vol 138 (5) ◽

pp. 527-536 ◽

Cited By ~ 123

Author(s):

Dominick J. Angiolillo ◽

Shaun G. Goodman ◽

Deepak L. Bhatt ◽

John W. Eikelboom ◽

Matthew J. Price ◽

...

Keyword(s):

Atrial Fibrillation ◽

Percutaneous Coronary Intervention ◽

Vitamin K ◽

Oral Anticoagulation ◽

Antithrombotic Therapy ◽

Oral Anticoagulant ◽

Coronary Intervention ◽

Vitamin K Antagonist ◽

Percutaneous Coronary ◽

Antithrombotic Management

The optimal antithrombotic treatment regimen for patients with atrial fibrillation undergoing percutaneous coronary intervention with stent implantation represents a challenge in clinical practice. In 2016, an updated opinion of selected experts from the United States and Canada on the treatment of patients with atrial fibrillation undergoing percutaneous coronary intervention was reported. After the 2016 North American consensus statement on the management of antithrombotic therapy in patients with atrial fibrillation undergoing percutaneous coronary intervention, results of pivotal clinical trials assessing the type of oral anticoagulant agent and the duration of antiplatelet treatment have been published. On the basis of these results, this focused update on the antithrombotic management of patients with atrial fibrillation undergoing percutaneous coronary intervention recommends that a non–vitamin K antagonist oral anticoagulant be preferred over a vitamin K antagonist as the oral anticoagulant of choice. Moreover, a double-therapy regimen (oral anticoagulant plus single antiplatelet therapy with a P2Y 12 inhibitor) by the time of hospital discharge should be considered for most patients, whereas extending the use of aspirin beyond hospital discharge (ie, triple therapy) should be considered only for selected patients at high ischemic/thrombotic and low bleeding risks and for a limited period of time. The present document provides a focused updated on the rationale for the new expert consensus–derived recommendations on the antithrombotic management of patients with atrial fibrillation treated with oral anticoagulation undergoing percutaneous coronary intervention.

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Reduced doses of direct oral anticoagulation are safe in atrial fibrillation patients with mild thrombocytopenia

Clinical Research in Practice The Journal of Team Hippocrates ◽

10.22237/crp/1567555920 ◽

2019 ◽

Vol 5 (2) ◽

Author(s):

Matthew Gross

Keyword(s):

Atrial Fibrillation ◽

Vitamin K ◽

Oral Anticoagulation ◽

Oral Anticoagulants ◽

Cardiovascular Pharmacology ◽

Vitamin K Antagonist

<p>Janion-Sadowska A, Papuga-Szela E, Łukaszuk R, Chrapek M, Undas A. Non–Vitamin K Antagonist Oral Anticoagulants in Patients With Atrial Fibrillation and Thrombocytopenia. <em>Journal of Cardiovascular Pharmacology</em>, 2018;72(3):153-160. doi: <a href="https://doi.org/10.1097/FJC.0000000000000607">10.1097/FJC.0000000000000607</a></p>

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Influence of renal function on vitamin K antagonist oral anticoagulation quality in non-valvular atrial fibrillation patients

Archives of Cardiovascular Diseases Supplements ◽

10.1016/j.acvdsp.2019.09.277 ◽

2020 ◽

Vol 12 (1) ◽

pp. 125-126

Author(s):

E. Allouche ◽

Z. Jabbari ◽

W. Sdiri ◽

S. Charfeddine ◽

M. Hassine ◽

...

Keyword(s):

Atrial Fibrillation ◽

Renal Function ◽

Vitamin K ◽

Oral Anticoagulation ◽

Vitamin K Antagonist

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Evaluation of Time in Therapeutic Range of Patients with Non-Valvular Atrial Fibrillation on Oral Anticoagulation with Vitamin K Antagonist in Delta Region

Cardiology and Angiology An International Journal ◽

10.9734/ca/2021/v10i330172 ◽

2021 ◽

pp. 32-38

Author(s):

Mohamed Kamel Abdel Aal ◽

Mohamed Bayoumi Nassar ◽

Abd El Latif El Gendy ◽

Seham Fahmy Badr

Keyword(s):

Atrial Fibrillation ◽

Vitamin K ◽

Therapeutic Range ◽

Oral Anticoagulation ◽

Statistical Significance ◽

Significant Proportion ◽

Vitamin K Antagonist ◽

Delta Region ◽

Time In Therapeutic Range ◽

Percent Time

Background: Non-valvular atrial fibrillation (AF) is the most common cardiac arrhythmia with a prevalence as high as 1.5±2.0% in the general population. This arrhythmia remains one of the major causes of stroke, heart failure, sudden death, and cardiovascular morbidity in the world. The aim of study was to evaluation of the patients in delta region who have non-valvular AF and on oral anticoagulation with Vitamin K antagonist as regard the time they spend within therapeutic range. Patients and Methods: A total of 100 patients were included in this study for evaluation of the patients in delta region who have non-valvular AF and on oral anticoagulation with Vitamin K antagonist as regard the time they spend within therapeutic range. Results: Our study showed that only 35% achieved the recommended TTR (percent time in therapeutic range) above 60% from studied risk factors, none showed statistical significance. Conclusions: The quality of anticoagulant control was lower that reported in European countries with a significant proportion of patients had TTR below 60%.

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