New oral anticoagulants versus vitamine K antagonists among patients with cardiac amyloidosis: effectiveness and safety

Abstract

Atrial fibrillation (AF) is common among patients with cardiac amyloidosis (CA), who have an increased risk of intracardiac thrombus. The aim of this study was to explore the effectiveness and safety of vitamin K-antagonists (VKA) and direct oral anticoagulants (DOAC) in patients with CA. Between January 2008 and April 2019, 163 patients with CA and history of AF receiving oral anticoagulant were enrolled in the study. There were 115 (71%) and 48 (29%) patients with VKA and DOAC, respectively. As compared to patients in the DOAC group, patients with VKA had more frequently light chain amyloidosis (39 versus 10%; P < 0.001), with a decreased renal function (estimated glomerular filtration rate 39 ± 22 versus 57 ± 16 ml/min; P < 0.001) and higher NT-proBNP level (4881 [2640–14124] versus 1829 [3460–5621]; P = 0.02). A total of 93 (57%) patients met the primary endpoint of all-cause mortality: 77 (67%) and 16 (33%) among patients with VKAs and DOACs, respectively ( P < 0.0001). After multivariate analysis including age and renal function, VKA was no longer associated with all-cause mortality HR 0.85 (95 M confident interval 0.38–1.87; P = 0.678). There was no difference between groups for thrombo-embolic events (17 versus 15%; P = 0.819) and no difference for bleeding complications (22 versus 21%; P = 1.000) Among patients with CA and AF receiving oral anticoagulant, VKA are associated with an increased mortality, which disappears after adjustment for age and renal function. Finally, DOAC do not show difference for effectiveness and safety than VKAs.