Key result
Direct oral anticoagulant therapy in patients with atrial fibrillation and a CRT device was associated with fewer bleeding events and no thromboembolic events over 24 months compared to warfarin.
Why the study?
The efficacy and safety of direct oral anticoagulant therapy after CRT device implantation in AF patients with CAD and DCM were not well studied.
Does DOAC therapy improve safety and efficacy compared to warfarin in patients with atrial fibrillation and an implanted CRT device?
Cohort (n=93)
Does DOAC therapy improve safety and efficacy compared to warfarin in patients with atrial fibrillation and an implanted CRT device?
DOAC therapy appears safe and effective for preventing thromboembolic events without increasing bleeding risk in patients with atrial fibrillation and implanted CRT devices compared to warfarin.
Aim. To study the efficacy and safety of direct oral anticoagulant (DOAC) therapy after implantation of cardiac resynchronization therapy (CRT) devices in atrial fibrillation (AF) patients with coronary artery disease (CAD) and dilated cardiomyopathy (DCM). Material and methods. The study included 93 patients followed up from 2014 to 2016 (71 men and 22 women) aged 33-85 years (59,7±10,6) with stable CAD (group 1, n=44) and DCM (group 2, n=49). All patients were diagnosed with AF. The left ventricular ejection fraction (LVEF) was 30,6±3,8%; the left ventricular end-diastolic dimension was 230,9±60,8 mm. All patients received anticoagulants for the prevention of thromboembolic events: a vitamin K antagonist (warfarin) or DOAC. The analysis of medical records, as well as ECG records, echocardiographic, 24-hour ECG monitoring data and information from implanted device was carried out. The follow-up period lasted 24 months. Results. After 24-month follow-up, positive dynamics was noted in all patients — LVEF increased from 30,6±3,7% to 39,5±5,8%). In patients with DCM, a more pronounced increase in myocardial contractile function was noted. Stroke within time interval from 12 to 24 months developed in two patients taking warfarin, from different groups. Transient ischemic attacks were observed in 6 patients: in one patient from group 1 during the period from inclusion and 12-month visit, and in 5 patients from 12 to 24 months. Out of 5 patients, two belonged to group 1 and three — to group 2, while one patient took aspirin and the other 4 — warfarin. One patient from group 1 with persistent AF and vitamin K antagonist therapy had left atrial appendage thrombosis. Hemorrhagic strokes and major bleeding have not been reported. Conclusion. Among patients taking DOAC, regardless of the underlying disease (CAD or DCM) and response to CRT, bleeding events were less often recorded, and there were no thromboembolic events.
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Kirgizova et al. (2021) conducted a cohort in Atrial fibrillation with coronary artery disease or dilated cardiomyopathy and an implanted CRT device (n=93). Direct oral anticoagulants (DOAC) vs. Vitamin K antagonist (warfarin) was evaluated on Thromboembolic and bleeding events. Direct oral anticoagulant therapy in patients with atrial fibrillation and a CRT device was associated with fewer bleeding events and no thromboembolic events over 24 months compared to warfarin.
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