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Efficacy and safety of non-vitamin K oral anticoagulants in hypertrophic cardiomyopathy with non-valvular atrial fibrillation: a nationwide cohort study

Session Atrial fibrillation in hypertrophic cardiomyopathy

Speaker Assistant Professor Pil-Sung Yang

Congress : ESC Congress 2018

  • Topic : arrhythmias and device therapy
  • Sub-topic : Hypertrophic Cardiomyopathy
  • Session type : Abstract Session
  • FP Number : 1468

Authors : H Jung (Seoul,KR), PS Yang (Seongnam,KR), E Jang (Seoul,KR), HT Yu (Seoul,KR), TH Kim (Seoul,KR), JS Uhm (Seoul,KR), JY Kim (Seoul,KR), JH Sung (Seongnam,KR), HN Pak (Seoul,KR), MH Lee (Seoul,KR), B Joung (Seoul,KR), GYH Lip (Birmingham,GB)

Authors:
H. Jung1 , P.S. Yang2 , E. Jang1 , H.T. Yu1 , T.H. Kim1 , J.S. Uhm1 , J.Y. Kim1 , J.H. Sung2 , H.N. Pak1 , M.H. Lee1 , B. Joung1 , G.Y.H. Lip3 , 1Yonsei University Health System, cardiology - Seoul - Korea Republic of , 2Bundang CHA Medical Center, CHA University - Seongnam - Korea Republic of , 3University of Birmingham, Institute of Cardiovascular Sciences - Birmingham - United Kingdom ,

Citation:
European Heart Journal ( 2018 ) 39 ( Supplement ), 274-275

Background: Chronic anticoagulation with warfarin is recommended in patients with hypertrophic cardiomyopathy (HCM) and atrial fibrillation (AF). Non-vitamin K oral anticoagulants (NOACs) are an alternative to warfarin but there are limited data to support their use in HCM.

Purpose: We sought to describe the pattern of use, stroke events, bleeding and mortality in patients with HCM and AF treated with NOACs, in comparison to those treated with warfarin.

Methods: Using the Korean National Health Insurance Service (NHIS) data during the period from 2011 to 2016, we identified patients with HCM and AF treated with NOACs (n=2302) and warfarin (n=1188). Comparisons on efficacy and safety outcomes were made on the basis of Cox-proportional hazards models stratified on 1:1 propensity score (PS)-matched NOAC (n=946) and warfarin groups (n=946).

Results: Baseline characteristics were well balanced between the two matched groups. Median age was 67 years (interquartile range: 58 to 74 years), 55.9% male, and median CHA2DS2-VASc score was 5 (interquartile range: 3 to 6). A total of 51.9% of the NOAC-treated patients received a reduced dose of dabigatran, rivaroxaban, or apixaban. After a mean 1.30 years of follow-up, the incidence of ischemic stroke and major bleeding were similar between NOAC- and warfarin treated patients. The incidence for ischemic stroke was 10.99 and 9.38 per 100 person-years for NOACs and warfarin, respectively (adjusted hazard ratio [aHR]: 0.996; 95% confidence interval [CI] 0.763–1.299; p=0.975). Major bleeding occurred in 5.48 per 100 person-years in the NOAC group vs. 5.26 in warfarin group (aHR: 0.932; 95% CI 0.649–1.338; p=0.703). However, patients treated with NOAC showed a significantly lower risk of all-cause mortality and the composite net clinical outcome (ischemic stroke, major bleeding, and all-cause death) compared to those on warfarin. The incidence of all-cause death was 4.98 and 10.69 per 100 person-years for NOACs and warfarin, respectively (aHR: 0.442; 95% CI 0.318–0.613; p<0.0001). The benefits were consistent across various high-risk subgroups.

Conclusions: Compared with those with warfarin, HCM patients with AF on NOACs had lower risk of all-cause mortality and similar risk of major bleeding and ischemic stroke.

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