Key result
Dabigatran and rivaroxaban show no significant association with fewer left atrial abnormalities versus VKAs.
Why the study?
Does dabigatran or rivaroxaban reduce left atrial abnormalities compared to vitamin K antagonists in patients with atrial fibrillation and atrial flutter?
Observational (n=306)
Yes
Does dabigatran or rivaroxaban reduce left atrial abnormalities compared to vitamin K antagonists in patients with atrial fibrillation and atrial flutter?
Effect estimate: OR 0.4 (95% CI 0.08-1.88)
Absolute Event Rate: 3% vs 9%
p-value: p=0.25
Dabigatran and rivaroxaban are associated with a similar incidence of left atrial abnormalities (thrombus, dense SEC, low LAA velocity) compared to vitamin K antagonists in patients with atrial fibrillation or flutter.
No difference in left atrial abnormalities with dabigatran or rivaroxaban versus VKAs; leaves open differential effects on thromboembolic markers.
BACKGROUND: Non-vitamin K antagonist oral anticoagulants (NOACs) such as dabigatran or rivaroxaban are alternatives to vitamin K antagonists (VKAs) for prevention of stroke and systemic embolism in patients with atrial fibrillation (AF) and atrial flutter (AFL). Incidences of risk factors for left atrium (LA) and left atrial appendage (LAA) thrombus formation, such as dense spontaneous echo contrast (SEC), low LAA velocity (LAAV) <20 cm/s under treatment with dabigatran and rivaroxaban in comparison with VKAs are unknown. METHODS: -VASc score were 1.3 and 2.5, respectively. Left atrial abnormality was defined as either dense SEC, low LAAV <20 cm/s, or thrombus. RESULTS: Any LA abnormality occurred in 9, 3, and 5 % of patients receiving VKA, dabigatran, and rivaroxaban, respectively. The most frequent abnormality was LAA thrombus (VKA: 4 %, dabigatran: 0 %, rivaroxaban: 2 %) and low LAAV of less than 20 cm/s (VKA: 4 %, dabigatran: 1 %, rivaroxaban: 1 %), followed by dense SEC (VKA: 2 %, dabigatran: 1 %, rivaroxaban: 2 %). Results of uni- and multivariate analyses revealed a numerically lower but not significantly different frequency of any LA abnormality under dabigatran (OR 0.4, 95 % Cl 0.08 - 1.88, p = 0.25) and rivaroxaban (OR 0.65, 95 % Cl 0.22 - 1.98, p = 0.45) compared to VKA. CONCLUSION: With respect to the incidence of LA abnormalities, dabigatran and rivaroxaban are not inferior to VKA.
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Reers et al. (2016) conducted an observational in Atrial fibrillation and atrial flutter (n=306). Dabigatran and Rivaroxaban vs. Vitamin K antagonists was evaluated on Any left atrial abnormality (OR 0.4, 95% CI 0.08-1.88, p=0.25). Dabigatran and rivaroxaban were associated with a non-significantly lower frequency of left atrial abnormalities compared to vitamin K antagonists (3% and 5% vs 9%, respectively).
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