In:
Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 144, No. Suppl_1 ( 2021-11-16)
Abstract:
Background: Whereas warfarin is the anticoagulation of choice for patients with atrial fibrillation (AF) and rheumatic mitral stenosis (MS), new oral anticoagulants are considered as alternatives in those with other VHD. Hypothesis: This study sought to compare the efficacy and safety of dabigatran therapy compared to the conventional treatment in valvular AF including MS. Methods: In this prospective, randomized controlled trial, we randomly assigned patients with AF and left-sided VHD to receive either dabigatran or conventional treatment. The primary end point was the composite of occurrences of clinical stroke and new cerebral lesion (silent cerebral infarct and microbleed) on brain magnetic resonance imaging (MRI) performed at the 1-year follow-up. Results: Between March 2017 and October 2019, 59 and 60 patients were randomly allocated to dabigatran and conventional treatment group, respectively. In the dabigatran group, all the patients were switched from anticoagulation (n=52), antiplatelet (n=5), or no therapy (n=2) to dabigatran. In the conventional treatment group, all the 42 patients with mitral stenosis continued anticoagulation with warfarin and the remaining 18 patients continued warfarin (n=11) or antiplatelets (n=7). During follow-up, no death or clinical stroke occurred in both groups and 1 major bleeding in the conventional treatment group. At 1-year follow-up brain MRI, silent ischemic infarct and microbleed occurred in 20 and 2 patients in the dabigatran group, and 20 and 4 patients in the conventional treatment group, respectively. The incidence of primary endpoint was not significantly different between the treatment groups (32.2% vs. 36.7%, relative risk [RR] 1.03, 95% confidence interval 0.63-1.31, 0.70-1.51, P=0.608). In the subset of the 82 patients with significant MS, the risk of primary endpoint was also similar between groups (32.5% vs. 33.3%, RR 0.96, 95% CI 0.63-1.54, P=0.936). Conclusions: The rates of primary end point after treatment with dabigatran were similar to those with conventional treatment in AF patients with MS and with other VHD. Thus, dabigatran could be a reasonable alternative to warfarin even in AF associated with MS.
Type of Medium:
Online Resource
ISSN:
0009-7322
,
1524-4539
DOI:
10.1161/circ.144.suppl_1.9763
Language:
English
Publisher:
Ovid Technologies (Wolters Kluwer Health)
Publication Date:
2021
detail.hit.zdb_id:
1466401-X
