Reers Stefan, Agdirlioglu Tolga, Kellner Michael, Borowski Matthias, Thiele Holger, Waltenberger Johannes, Reppel Michael
Department of Cardiovascular Medicine, University Hospital Muenster, 48149, Muenster, Germany.
Department of Cardiology/Angiology/Intensive Care Medicine, University Heart Center Luebeck, Luebeck, Germany.
Eur J Med Res. 2016 Oct 21;21(1):41. doi: 10.1186/s40001-016-0235-8.
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.
We studied 306 patients with AF (94 %) and AFL (6 %) undergoing transesophageal echocardiography. Patients received VKAs (n = 138), dabigatran (n = 68), or rivaroxaban (n = 100) for at least 3 weeks prior to investigation. Time in therapeutic range was 67 % for VKA. Mean CHADS score and CHADS-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.
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.
With respect to the incidence of LA abnormalities, dabigatran and rivaroxaban are not inferior to VKA.
达比加群或利伐沙班等非维生素K拮抗剂口服抗凝药（NOACs）是维生素K拮抗剂（VKAs）用于预防心房颤动（AF）和心房扑动（AFL）患者发生中风和全身性栓塞的替代药物。与VKAs相比，在接受达比加群和利伐沙班治疗的患者中，左心房（LA）和左心耳（LAA）血栓形成的危险因素发生率，如密集的自发回声增强（SEC）、低LAA速度（LAAV）<20 cm/s，尚不清楚。
我们研究了306例接受经食管超声心动图检查的AF（94%）和AFL（6%）患者。在检查前，患者接受VKAs（n = 138）、达比加群（n = 68）或利伐沙班（n = 100）治疗至少3周。VKA的治疗范围内时间为67%。平均CHADS评分和CHADS-VASc评分分别为1.3和2.5。左心房异常定义为密集的SEC、低LAAV<20 cm/s或血栓。
接受VKA、达比加群和利伐沙班治疗的患者中，分别有9%、3%和5%出现任何LA异常。最常见的异常是LAA血栓（VKA：4%，达比加群：0%，利伐沙班：2%）和LAAV低于20 cm/s（VKA：4%，达比加群：1%，利伐沙班：1%），其次是密集的SEC（VKA：2%，达比加群：1%，利伐沙班：2%）。单因素和多因素分析结果显示，与VKA相比，达比加群（OR 0.4，95% CI 0.08 - 1.88，p = 0.25）和利伐沙班（OR 0.65，95% CI 0.22 - 1.98，p = 0.45）治疗下任何LA异常的发生率在数值上较低，但无显著差异。
就LA异常的发生率而言，达比加群和利伐沙班并不逊于VKA。
