Division of Cardiovascular Medicine, Endocrinology and Metabolism, Department of Molecular Medicine and Therapeutics, Faculty of Medicine, Tottori University, Yonago, Japan; Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan.
Institute for Clinical Research, National Hospital Organization, Osaka National Hospital, Osaka, Japan.
Thromb Res. 2017 Dec;160:69-75. doi: 10.1016/j.thromres.2017.10.027. Epub 2017 Nov 6.
The prevalence of atrial fibrillation (AF) is high in elder subjects. Our previous observational study suggested that vitamin K antagonist (VKA) promotes aortic valve degeneration, a principal cause of aortic stenosis in the elderly, and that angiotensin receptor blocker (ARB) attenuates its progression. This study aimed to prospectively investigate these observations in non-valvular AF patients.
Of enrolled 430 patients with calcification on no or one aortic valve leaflet, all of the planned 4-year follow-up data were obtained in 122 non-valvular AF patients treated with warfarin (warfarin group) and 101 patients with cardiovascular diseases and without AF and prescription of warfarin (non-warfarin group).
Despite higher atherosclerotic risks in the non-warfarin group, 2 or 3 newly calcified leaflets emerged during 4years in 18.0% of patients in the warfarin group and in 6.9% in the non-warfarin group (p=0.014). Aortic valve area (AVA) did not significantly change in the non-warfarin group during the follow-up, but tended to decrease in the warfarin group (p=0.057). Non-vitamin K antagonist oral anticoagulant got available in Japan after this study started, and warfarin was discontinued in 15 patients of the warfarin group. The reduction of AVA was significant in the remaining 107 patients on the continuous warfarin treatment (p=0.002). The effects of ARB on AVA were obscure.
Major bleeding associated with VKA is well recognized. This study suggests that the development of aortic valve degeneration is another risk of long-term use of VKA in non-valvular AF patients with no or mild aortic valve degeneration.
心房颤动（AF）在老年患者中较为常见。我们之前的观察性研究表明，维生素 K 拮抗剂（VKA）可促进主动脉瓣退化，这是老年人主动脉瓣狭窄的主要原因，而血管紧张素受体阻滞剂（ARB）可减轻其进展。本研究旨在前瞻性研究非瓣膜性 AF 患者的这些观察结果。
在纳入的 430 例主动脉瓣无或一叶瓣钙化的患者中，所有计划的 4 年随访数据均在 122 例接受华法林治疗的非瓣膜性 AF 患者（华法林组）和 101 例患有心血管疾病且未服用华法林的患者（非华法林组）中获得。
尽管非华法林组的动脉粥样硬化风险较高，但在华法林组中，18.0%的患者在 4 年内出现 2 或 3 个新钙化瓣叶，而非华法林组为 6.9%（p=0.014）。非华法林组在随访期间主动脉瓣口面积（AVA）无明显变化，但华法林组有下降趋势（p=0.057）。本研究开始后，日本出现了非维生素 K 拮抗剂口服抗凝剂，华法林在华法林组的 15 例患者中停用。在继续服用华法林的 107 例患者中，AVA 的减少具有统计学意义（p=0.002）。ARB 对 AVA 的影响尚不清楚。
VKA 相关的大出血是众所周知的。本研究表明，在无或轻度主动脉瓣退化的非瓣膜性 AF 患者中，长期使用 VKA 可导致主动脉瓣退化的发展。
