Patients with cardiac amyloidosis presenting with heart failure and new-onset atrial fibrillation (AFib) may benefit from direct oral anticoagulants (DOACs) more than vitamin K antagonists (VKAs), according to new data published in the American Journal of Cardiology.
“AFib is present in approximately 40% of patients with cardiac amyloidosis,” wrote first author Amgad Mentias, MD, MS, a cardiologist with Cleveland Clinic, and colleagues. “AFib in the setting of cardiac amyloidosis is associated with a significant risk of stroke and systemic thromboembolism … although current guidelines recommend anticoagulation therapy in all patients with cardiac amyloidosis and AFib, data about the comparative effectiveness and safety of VKAs and DOACs in this patient population are scarce.”
Mentias et al. examined data from 551 Medicare patients who were treated from January 2015 to November 2019. While 61.3% of patients were prescribed one of three popular DOACs (apixaban, rivaroxaban or dabigatran) the remaining 38.7% were prescribed warfarin, a common VKA.
The mean age of the DOAC group was 77.6 years old, and the mean age of the VKA group was 77 years old. The percentage of male patients was 63.6% for the DOAC group and 60.6% for the VKA group. The median CHA₂DS₂-VASc score was five for both groups.
Overall, after a median follow-up period of 444 days, treatment with a DOAC was associated with a reduced risk of mortality, stroke or major bleeding. The reduction in stroke risk was “driven mainly by ischemic stroke, not hemorrhagic stroke.”
The study did have certain limitations, the authors noted, including its lack of imaging data and exclusive focus on Medicare patients.
The full analysis is available here.
Michael has more than 16 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.