Division of Cardiology, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA.
Cleerly, New York, NY.
Am J Ther. 2023;30(4):e313-e320. doi: 10.1097/MJT.0000000000001569. Epub 2022 Oct 18.
Direct oral anticoagulants (DOACs) have been associated with less calcification and coronary plaque progression than warfarin. Whether different DOACs have different effects on coronary plaque burden and progression is not known. We compared the 12-month effects of apixaban and rivaroxaban on plaque characteristics and vascular morphology in patients with atrial fibrillation through quantitative cardiac computed tomographic angiography.
In patients with nonvalvular atrial fibrillation using apixaban or rivaroxaban, are there differences in plaque quantification and progression measured with cardiac computed tomography?
This is a post hoc analysis of 2 paired prospective, single-centered, randomized, open-label trials with blinded adjudication of results. In total, 74 patients were prospectively randomized in parallel trials: 29 to apixaban (2.5-5 mg BID) and 45 to rivaroxaban (20 mg QD). Serial cardiac computed tomographic angiography was performed at baseline and 52 weeks.
Comprehensive whole-heart analysis was performed for differences in the progression of percent atheroma volume (PAV), calcified plaque (CP) PAV, noncalcified plaque (NCP) PAV, positive arterial remodeling (PR) ≥1.10, and high-risk plaque (Cleerly Labs, New York, NY).
Both groups had progression of all 3 plaque types (apixaban: CP 8.7 mm 3 , NCP 69.7 mm 3 , and LD-NCP 27.2 mm 3 ; rivaroxaban: CP 22.9 mm 3 , NCP 66.3 mm 3 , and LD-NCP 11.0 mm 3 ) and a total annual plaque PAV change (apixaban: PAV 1.5%, PAV-CP 0.12%, and PAV-NCP 0.92%; rivaroxaban: PAV 2.1%, PAV-CP 0.46%, and PAV-NCP 1.40%). There was significantly lower PAV-CP progression in the apixaban group compared with the rivaroxaban group (0.12% vs. 0.46% P = 0.02). High-risk plaque characteristics showed a significant change in PR of apixaban versus rivaroxaban ( P = 0.01). When the propensity score weighting model is applied, only PR changes are statistically significant ( P = 0.04).
In both groups, there is progression of all types of plaque. There was a significant difference between apixaban and rivaroxaban on coronary calcification, with significantly lower calcific plaque progression in the apixaban group, and change in positive remodeling. With weighted modeling, only PR changes are statistically significant between the 2 DOACs.
与华法林相比，直接口服抗凝剂（DOAC）与较少的钙化和冠状动脉斑块进展相关。不同的 DOAC 是否对冠状动脉斑块负担和进展有不同的影响尚不清楚。我们通过定量心脏计算机断层血管造影术比较了使用阿哌沙班和利伐沙班的非瓣膜性心房颤动患者 12 个月的斑块特征和血管形态。
在使用阿哌沙班或利伐沙班的非瓣膜性心房颤动患者中，心脏计算机断层扫描测量的斑块定量和进展是否存在差异？
这是两项前瞻性、单中心、随机、开放标签配对试验的事后分析，结果由盲法裁决。共有 74 名患者前瞻性随机分为平行试验组：29 名接受阿哌沙班（2.5-5mg BID）治疗，45 名接受利伐沙班（20mg QD）治疗。基线和 52 周时进行连续心脏计算机断层血管造影。
对动脉粥样硬化体积（PAV）、钙化斑块（CP）PAV、非钙化斑块（NCP）PAV、阳性动脉重构（PR）≥1.10 和高危斑块（Cleerly Labs，纽约，NY）的进展进行了全面的全心脏分析。
两组均有所有 3 种斑块类型的进展（阿哌沙班：CP 8.7mm³、NCP 69.7mm³和 LD-NCP 27.2mm³；利伐沙班：CP 22.9mm³、NCP 66.3mm³和 LD-NCP 11.0mm³）和总年度斑块 PAV 变化（阿哌沙班：PAV 1.5%、PAV-CP 0.12%和 PAV-NCP 0.92%；利伐沙班：PAV 2.1%、PAV-CP 0.46%和 PAV-NCP 1.40%）。与利伐沙班相比，阿哌沙班组的 CP 进展明显更低（0.12% vs. 0.46%，P=0.02）。阿哌沙班与利伐沙班相比，高危斑块特征的 PR 变化具有统计学意义（P=0.01）。当应用倾向评分加权模型时，只有 PR 变化具有统计学意义（P=0.04）。
两组均有所有类型斑块的进展。阿哌沙班和利伐沙班在冠状动脉钙化方面存在显著差异，阿哌沙班组的钙化斑块进展明显较低，而正性重构发生变化。经加权建模后，只有这两种 DOAC 之间的 PR 变化具有统计学意义。
