Abstract 10456: Direct Oral Anticoagulant is Associated with a Lower Prevalence of Thin-Cap Fibroatheroma in Patients with Coronary Artery Disease

Abstract

Introduction: The reduced incidence of cardiovascular events in patients with direct oral anticoagulant (DOAC) has been demonstrated. However, the association between taking DOAC and the characteristic of coronary plaque remains to be elucidated. Hypothesis: Taking DOAC is associated with a lower prevalence of vulnerable plaque in patients with coronary artery disease (CAD). Methods: A total of 2168 coronary plaques in consecutive 1439 patients who underwent optical coherence tomography imaging of the culprit or non-culprit lesion were analyzed. The prevalence of thin-cap fibroatheroma (TCFA) were compared between patients with DOAC (149 plaques in 105 patients) and those without (2019 plaques in 1334 patients). Results: The prevalence of TCFA was significantly lower in patients with DOAC than those without in both culprit lesion (27.3% vs. 15.4%, p=0.002) and non-culprit lesion (22.1% vs. 5.2%, p<0.001) (Panel A). In addition to P2Y12 inhibitor intake (odds ratio: 0.941 [95% confidence interval: 0.890-0.995], p=0.034), taking DOAC was independently associated with a lower prevalence of TCFA at any lesion (odds ratio: 0.891 [95% confidence interval: 0.837-0.949], p<0.001) after adjustment of confounders. The prevalence of TCFA at any lesion was significantly lower in patients with a combination of DOAC and P2Y12 inhibitor than those on either DOAC or P2Y12 inhibitor and those without (Panel B). Conclusions: Taking DOAC was associated with a lower prevalence of TCFA in patients with CAD. The present results may partly explain the efficacy of DOAC on the reduced incidence of cardiovascular events in patients with CAD.