Non-vitamin K antagonist oral anticoagulants and heart failure

作者：Isnard Richard; Bauer Fabrice; Cohen Solal Alain; Damy Thibaud; Donal Erwan; Galinier Michel; Hagege Albert; Jourdain Patrick; Leclercq Christophe; Sabatier Remi; Trochu Jean Noel; Cohen Ariel

来源：Archives of Cardiovascular Diseases, 2016, 109(11): 641-650.

DOI：10.1016/j.acvd.2016.08.001

• Non-vitamin K antagonist oral anticoagulants
• Vitamin K antagonists
• Atrial fibrillation
• Heart failure
• Stroke

Thromboembolism contributes to morbidity and mortality in patients with heart failure (HF), and atrial fibrillation (AF) is one of the main factors promoting this complication. As they share many risk factors, HF and AF frequently coexist, and patients with both conditions are at a particularly high risk of thromboembolism. Non-vitamin K antagonist oral anticoagulants (NOACs) are direct antagonists of thrombin (dabigatran) and factor Xa (rivarox-aban, apixaban and edoxaban), and were designed to overcome the limitations of vitamin K antagonists. Compared with warfarin in non-valvular AF, NOACs demonstrated non-inferiority with better safety, most particularly for intracranial haemorrhages. Therefore, the European Society of Cardiology guidelines recommend NOACs for most patients with non-valvular AF. Subgroups of patients with both AF and HF from the pivotal studies investigating the safety and efficacy of NOACs have been analysed and, for each NOAC, results were similar to those of the total analysis population. A recent meta-analysis of these subgroups has confirmed the better efficacy and safety of NOACs in patients with AF and HF particularly the 41% decrease in the incidence of intracranial haemorrhages. The prothrombotic state associated with HF suggests that patients with HF in sinus rhythm could also benefit from treatment with NOACs. However, in the absence of clinical trial data supporting this indication, current guidelines do not recommend anticoagulant treatment of patients with HF in sinus rhythm. In conclusion, recent analyses of pivotal studies support the use of NOACs,in accordance with their indications in HF patients with non-valvular AF.

• 出版日期2016-11