Clinical Analysis Of Non-vitamin K Antagonist Oral Anticoagulants In Patients With Hypertrophic Cardiomyopathy With Non-valvular Atrial Fibrillation

Background and ObjectiveHypertrophic cardiomyopathy(HCM)patients with nonvalvular atrial fibrillation(AF)are at a high occurrence of thromboembolic events.At present,domestic guidelines recommend the use of vitamin K antagonists(VKA)for anticoagulation treatment,while there is limited research data on the clinical use of non-vitamin K antagonists oral anticoagulants(NOACs).This retrospective study sought to investigate the effectiveness and safety of NOACs in patients with HCM-AF.MethodsRetrospective analysis was performed on patients with HCM-AF admitted to and treated with anticoagulant therapy from January 2015 to December 2019.According to inclusion and exclusion criteria,a total of 232 patients with HCM and non-valvular atrial fibrillation receiving oral anticoagulant therapy were included and followed up until March 31,2020.General data and cardiac ultrasound of selected patients during hospitalization were collected.In the Kaplan-Meier analysis,the risk of clinical outcome in patients treated with NOACS was assessed using VKA as the reference.The Cox model was used to estimate hazard ratios for major or clinical bleeding with 95%confidence intervals.Results1.Of 232 patients,90 patients(38.8%)received warfarin therapy(VKA group)and 142patients(61.2%)received NOACS(NOACS group)at the last evaluation.There were no statistically significant differences in age,sex,SBP,DBP,heart rate,CHA2DS2-VASc score,HAS-BLEED score,atrial fibrillation type,and clinical complications between the two groups(P > 0.05).2.There were no statistically significant differences in cardiac ultrasound indicators between the two groups,including LVEF,E/ E,LA diameter,MWT,MWT/ LVPWT,obstructive HCM,and mitral SAM(P > 0.05).There were no significant differences in TC,TG,LDL,HDL,NT-pro BNP,TNI,D-D,FBG,Hb A1 c,ALT,AST,CR,GFR,PLT and HGB(P > 0.05)between the two groups.3.Kaplan-Meier survival curve analysis showed that the risk of major or clinically related bleeding in the NOACS group was lower than that in the VKA group,and the difference was statistically significant(Log rank P=0.022).There were no significant differences in the incidence of all-cause death(log rank P=0.483),cardiovascular death(log rank P=0.888),and thromboembolic events(log rank P=0.996)in the NOACS treatment group compared with the VKA group(P > 0.05).4.In Cox multiple regression analysis,age(HR 1.11,95%CI :1.05‐1.18;P=0.001)and warfarin therapy(HR 3.89,95% CI: 1.48‐10.24;P=0.006)proved to be an independent predictor of major or clinically relevant bleeding.Compared with warfarin,NOACs were associated with a lower risk of major or clinically related bleeding regardless of gender,hypertension,diabetes,previous ischemic stroke/TIA,chronic liver disease,and chronic kidney disease(P< 0.05).5.In NOACs subgroup analysis,there were no significant differences in clinical characteristics and baseline data between rivaroxaban group and Dabigat group(P >0.05).In the analysis of long-term clinical events and Kaplan-Meier survival curve,there were no significant differences in all-cause death,cardiovascular death,thromboembolic events,major bleeding or clinically related bleeding events between the two groups(P > 0.05).ConclusionsCompared with warfarin,HCM patients with AF treated with NOACs showed risk reduction of major or clinically related bleeding,with similar incidences of all-cause death,cardiovascular death or thromboembolic events.