Direct Oral Anticoagulants Versus Warfarin in Patients with Atrial Fibrillation and Hypertrophic Cardiomyopathy: A Retrospective Cohort Study.

BACKGROUND

The optimal anticoagulation strategy for patients with atrial fibrillation (AF) and obstructive hypertrophic cardiomyopathy (oHCM) remains unclear. This study compared the outcomes of direct oral anticoagulants (DOACs) versus warfarin in this patient population.

METHODS

Data from the TriNetX Research Network were used to identify patients with AF and oHCM treated with either DOACs or warfarin. Patients with a prior history of stroke were excluded. Propensity score matching (PSM) was performed to balance baseline characteristics. The primary outcome was ischemic stroke. Secondary outcomes included: all-cause death, all-cause hospitalization, acute myocardial infarction, gastrointestinal bleed, hematuria, and brain hemorrhage. Hazard ratios (HRs) were estimated by Cox proportional hazard models.

RESULTS

A total of 7090 patients in the DOAC group and 3350 in the warfarin group were included prior to PSM. Following PSM, each cohort included 3307 patients. The incidence of ischemic stroke was lower in the DOAC group (3.5%) compared with the warfarin group (4.8%), with a hazard ratio (HR) of 0.74 (95% confidence interval [CI]: 0.58-0.95). All-cause mortality was similar between groups, with 555 (16.8%) deaths in the DOAC group and 575 (17.4%) in the warfarin group (HR: 0.996, 95% CI: 0.89-1.12). All-cause hospitalization rates were lower in the DOAC group (64.5%) compared with the warfarin group (68.7%) (HR: 0.90, 95% CI: 0.85-0.95). No significant differences were observed in the rates of acute myocardial infarction (12.1% versus 12.2%; HR: 1.01, 95% CI: 0.88-1.16), gastrointestinal bleeding (6.9% versus 7.9%; HR: 0.89, 95% CI: 0.74-1.06), hematuria (8.0% versus 8.5%; HR: 0.96, 95% CI: 0.82-1.14), or intracranial hemorrhage (1.5% versus 2.0%; HR: 0.75, 95% CI: 0.52-1.09) between groups.

CONCLUSIONS

DOACs demonstrated a lower risk of ischemic stroke and all-cause hospitalization rates compared with warfarin in patients with AF and oHCM, supporting the use of DOACs in this patient population.