Effectiveness and Safety of Non-Vitamin K Antagonist Oral Anticoagulants in Patients With Atrial Fibrillation With Hypertrophic Cardiomyopathy: A Nationwide Cohort Study

Hyunjean Jung, Pil Sung Yang, Eunsun Jang, Hee Tae Yu, Tae Hoon Kim, Jae Sun Uhm, Jong Youn Kim, Hui Nam Pak, Moon Hyoung Lee, Boyoung Joung, Gregory Y.H. Lip

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16 Citations (Scopus)

Abstract

Background: Chronic anticoagulation is recommended in patients with hypertrophic cardiomyopathy (HCM) and atrial fibrillation (AF). Non-vitamin K antagonist oral anticoagulants (NOACs) are an alternative to warfarin, but there are limited data to support their use in patients with HCM and AF. We sought to compare thromboembolic events, bleeding, and mortality between NOAC and warfarin in patients with HCM and AF. Methods: From the Korean National Health Insurance Service database during the period from January 1, 2011, to December 31, 2016, we identified a warfarin-treated group of patients with HCM and AF (n = 955) who were compared with a 1:2 propensity-matched NOAC treated group (n = 1,504). Results: After a median follow-up of 16 months, the incidence rates of ischemic stroke and major bleeding were similar between NOAC- and warfarin-treated patients with HCM and AF. NOAC-treated patients had lower incidence rates for all-cause mortality (5.11 and 10.13 events per 100 person-years for NOAC and warfarin groups) and the composite of fatal cardiovascular events (0.77 and 1.80 events per 100 person-years). Compared with warfarin, use of NOACs was associated with a significantly lower risk of all cause-mortality (hazard ratio, 0.43; 95% CI, 0.32-0.57) and composite fatal cardiovascular events (hazard ratio, 0.39; 95% CI, 0.18-0.82). Conclusions: Compared with warfarin, patients with HCM and AF on NOACs had similar stroke and major bleeding risks, but lower all-cause mortality and composite fatal cardiovascular events. Our data suggest that patients with HCM and AF can be safely and effectively treated with NOACs.

Original languageEnglish
Pages (from-to)354-363
Number of pages10
JournalChest
Volume155
Issue number2
DOIs
Publication statusPublished - 2019 Feb

Bibliographical note

Funding Information:
Author contributions: B. J. and G. Y. H. L. are guarantors and take responsibility for the content of this manuscript. H. J., P.-S. Y., E.J., G. Y. H. L., and B. J. contributed to the original idea, data analyses, and manuscript drafting and revisions; H.-T. Y., T.-H. K., J.-S. U., J.-Y. K., H.-N. P., and M.-H. L. contributed to the manuscript drafting and revisions., Financial/nonfinancial disclosure: The authors have reported to CHEST the following: G. Y. H. L. has served as a consultant for Bayer/Janssen, BMS/Pfizer, Medtronic, Boehringer Ingelheim, Novartis, Verseon, and Daiichi-Sankyo, and as a speaker for Bayer, BMS/Pfizer, Medtronic, Boehringer Ingelheim, and Daiichi-Sankyo. No fees were directly received personally. None declared (H. J., P.-S. Y., E. J., H. T. Y., T.-H. K., J.-S. U., J.-Y. K., H.-N. P., M.-H. L., B. J.)., Role of sponsors: The sponsor had no role in the design of the study, the collection and analysis of the data, or the preparation of the manuscript., Other contributions: The National Health Information Database was provided by the National Health Insurance Service of Korea. (NHIS) (NHIS-2018-4-019). The authors thank the National Health Insurance Service for its cooperation., Additional information: The e-Appendixes, e-Figures, and e-Tables can be found in the Supplemental Materials section of the online article.

All Science Journal Classification (ASJC) codes

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

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