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Войти в исследования Journal of the American Heart Association · 2026
Efficacy and Safety of Direct-Acting Oral Anticoagulants in Atrial Fibrillation With Hypertrophic Cardiomyopathy.
СтатьяПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Taha Amro, Mondal Avilash, Akbar Usman Ali, Li Aobo, Sandhyavenu Harigopal, Alhajji Mohamed, Thangjui Sittinun, Thyagaturu Harshith, Bianco Christopher, Caccamo Marco, Masri Ahmad, Balla Sudarshan
Аннотация
BACKGROUND: Patients with hypertrophic cardiomyopathy (HCM) were excluded from pivotal trials comparing the efficacy and safety of direct oral anticoagulants (DOACs) and vitamin K antagonists.
METHODS: Our retrospective cohort study using the TriNetX database compared adults with HCM-atrial fibrillation who initiated DOACs or vitamin K antagonists. The primary outcomes were all-cause mortality and ischemic stroke/systemic thromboembolism. Secondary outcomes included major bleeding, intracranial hemorrhage, gastrointestinal bleeding, and all-cause hospitalization. Subgroup analysis was conducted for obstructive HCM.
RESULTS: Among 13 143 patients with HCM-atrial fibrillation (2963 matched pairs). DOAC use was associated with lower all-cause mortality (hazard ratio [HR], 0.82[ 95% CI, 0.73-0.93]; P<0.001), major bleeding (HR, 0.85 [95% CI, 0.73-0.99]; P=0.03), and intracranial hemorrhage (HR, 0.54 [95% CI, 0.36-0.79]; P=0.001) compared with vitamin K antagonists. No differences were observed in the rates of ischemic stroke (HR, 0.94 [95% CI, 0.73-1.2]; P=0.6) or the composite of stroke or systemic thromboembolism (HR, 0.87 [95% CI, 0.69-1.10]; P=0.25), gastrointestinal bleeding (HR, 0.97 [95% CI, 0.77-1.22]; P=0.82), or all-cause hospitalizations (HR, 1.07 [95% CI, 0.93-1.07]; P=0.051). In the subgroup with obstructive HCM, DOAC use was associated with a reduced risk of all-cause mortality (HR, 0.80 [95% CI, 0.66-0.99]; P=0.035) and major bleeding (HR, 0.76 [95% CI, 0.61-0.96]; P=0.02) without stroke or thromboembolic risk reduction (HR, 0.69 [95% CI, 0.47-1.01]; P=0.05).
CONCLUSIONS: Among patients with HCM-atrial fibrillation, DOACs were associated with lower mortality and bleeding risk compared with vitamin K antagonists, with no increased risk of stroke or systemic thromboembolism.
METHODS: Our retrospective cohort study using the TriNetX database compared adults with HCM-atrial fibrillation who initiated DOACs or vitamin K antagonists. The primary outcomes were all-cause mortality and ischemic stroke/systemic thromboembolism. Secondary outcomes included major bleeding, intracranial hemorrhage, gastrointestinal bleeding, and all-cause hospitalization. Subgroup analysis was conducted for obstructive HCM.
RESULTS: Among 13 143 patients with HCM-atrial fibrillation (2963 matched pairs). DOAC use was associated with lower all-cause mortality (hazard ratio [HR], 0.82[ 95% CI, 0.73-0.93]; P<0.001), major bleeding (HR, 0.85 [95% CI, 0.73-0.99]; P=0.03), and intracranial hemorrhage (HR, 0.54 [95% CI, 0.36-0.79]; P=0.001) compared with vitamin K antagonists. No differences were observed in the rates of ischemic stroke (HR, 0.94 [95% CI, 0.73-1.2]; P=0.6) or the composite of stroke or systemic thromboembolism (HR, 0.87 [95% CI, 0.69-1.10]; P=0.25), gastrointestinal bleeding (HR, 0.97 [95% CI, 0.77-1.22]; P=0.82), or all-cause hospitalizations (HR, 1.07 [95% CI, 0.93-1.07]; P=0.051). In the subgroup with obstructive HCM, DOAC use was associated with a reduced risk of all-cause mortality (HR, 0.80 [95% CI, 0.66-0.99]; P=0.035) and major bleeding (HR, 0.76 [95% CI, 0.61-0.96]; P=0.02) without stroke or thromboembolic risk reduction (HR, 0.69 [95% CI, 0.47-1.01]; P=0.05).
CONCLUSIONS: Among patients with HCM-atrial fibrillation, DOACs were associated with lower mortality and bleeding risk compared with vitamin K antagonists, with no increased risk of stroke or systemic thromboembolism.