Direct oral anticoagulants in patients with hypertrophic cardiomyopathy and atrial fibrillation

Abstract

Word Count: 3795 (excluding abstract, references, tables and figure legends). Conflict of interestDr Garcia Pinilla has received speaking fees from Bristol-Myers Squibb (BMS) and Pfizer Inc. and payments for consultancy from Bayer. Dr Garcia-Pavia has received speaking fees and payments for consultancy from Bayer, BMS and Pfizer Inc. BMS and Pfizer Inc.have also provided research support to Dr Dominguez and Garcia-Pavia's institution. Methods:Data from patients treated with NOACs (n=99) and VKA (n=433) at 9 inherited cardiac diseases units were retrospectively collected. Annual rates of embolic events, serious bleeding and death were analysed and compared. Quality of life and treatment satisfaction were evaluated with SF-36 and SAFUCA questionnaires in 80 NOAC-treated and 57 VKA-treated patients. Results:After median follow-up of 63 months (IQR:26-109), thromboembolic events A C C E P T E D M A N U S C R I P T ACCEPTED MANUSCRIPT6 Quality of life scores were similar in both groups; however, NOAC-treated patients achieved higher scores in the SAFUCA. Conclusions:HCM patients with AF on NOACs showed similar embolic and bleeding rates to those on VKA. Although quality of life was similar in both groups, the NOAC group reported higher treatment satisfaction.Word count: 250

National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand: Australian Clinical Guidelines for the Diagnosis and Management of Atrial Fibrillation 2018

“…Given the significantly increased risk of thromboembolic events (incidence of 3.8% annually [194]), anticoagulation is recommended in all HCM patients who develop AF [196,200,350]. Limited data exist for the use of NOACs, but observational studies suggest that their use can be safe and effective in HCM patients with AF [351,352]. 6.…”

Clinical presentations of hypertrophic cardiomyopathy and implications for therapy

“…Long-term anticoagulation is recommended for all patients with HCM patients who present with AF, irrespective of predictive risk scores such as CHA2DS2-VASc score 35, 40 . Vitamin-K antagonists are considered the first choice in this setting 35 , although direct anticoagulants are suitable alternatives for thromboembolic prevention, and might be preferred in selected individuals 41 .…”

Clinical Profile of Thromboembolic Events in Patients With Hypertrophic Cardiomyopathy in a Regional Japanese Cohort ― Results From Kochi RYOMA Study ―

“…Recently, some reports showed that HCM patients with AF on DOACs had similar embolic and bleeding risks as those on warfarin. 18,19 The guidelines may be changed when data on embolic and bleeding rates in HCM patients with AF who are receiving DOACs accumulates.…”