Non-vitamin K antagonist oral anticoagulants and heart failure

被引：13

作者：

Isnard, Richard ^{[1
,2
]}

Bauer, Fabrice ^{[3
]}

Cohen-Solal, Alain ^{[4
]}

Damy, Thibaud ^{[5
]}

Donal, Erwan ^{[6
]}

Galinier, Michel ^{[7
]}

Hagege, Albert ^{[8
]}

Jourdain, Patrick ^{[9
]}

Leclercq, Christophe ^{[10
]}

Sabatier, Remi ^{[11
]}

Trochu, Jean-Noel ^{[12
]}

Cohen, Ariel ^{[13
]}

机构：

[1] Univ Paris 06, Pitie Salpetriere Hosp, AP HP,Inserm UPMC 1166, Fac Med Pierre & Marie Curie,Dept Cardiol,UMRS, F-75013 Paris, France

[2] Inst Cardiometab & Nutr ICAN, F-75013 Paris, France

[3] Rouen Univ Hosp, Dept Cardiol, INSERM, U1096, F-76031 Rouen, France

[4] Paris Diderot Univ, Sorbonne Paris Ctr, Lariboisiere Hosp, Dept Cardiol,UMRS 942, F-75013 Paris, France

[5] Henri Mondor Teaching Hosp, AP HP, Mondor Amyloidosis Network, UPEC,Dept Cardiol,DHU ATVB,Inserm,U955, F-94010 Creteil, France

[6] Univ Rennes 1, Rennes Univ Hosp, Dept Cardiol, LTSI,Inserm,UMR 1099, F-35033 Rennes, France

[7] Univ Paul Sabatier Toulouse 3, Equipe Obesite & Insuffisance Cardiaque Approches, Fac Med, Inserm,UMR 1048 I2MC, F-31432 Toulouse, France

[8] Paris Descartes Univ, Georges Pompidou European Hosp, AP HP, Dept Cardiol,PRES Paris Cite, F-75015 Paris, France

[9] CHR Dubos, UTIC, Ecole Coeur & Anticoagulants, F-95300 Pontoise, France

[10] Rennes Univ Hosp, Dept Cardiol, CIC IT, F-35033 Rennes, France

[11] Caen Univ Hosp, Dept Cardiol, F-14003 Caen, France

[12] Univ Nantes, CHU Nantes, Dept Cardiol & Vasc Dis, Inst Thorax,Inserm,UMR 1087,CIC 1413, F-44093 Nantes, France

[13] Univ Paris 06, St Antoine Hosp, AP HP, Fac Med Pierre & Marie Curie,Dept Cardiol, F-75012 Paris, France

来源：

ARCHIVES OF CARDIOVASCULAR DISEASES | 2016年 / 109卷 / 11期

关键词：

Non-vitamin K antagonist oral anticoagulants; Vitamin K antagonists; Atrial fibrillation; Heart failure; Stroke; PERSISTENT ATRIAL-FIBRILLATION; LEFT-VENTRICULAR DYSFUNCTION; VENOUS THROMBOEMBOLISM; RANDOMIZED-TRIAL; ISCHEMIC-STROKE; WARFARIN; RISK; PREVENTION; EFFICACY; THERAPY;

D O I：

10.1016/j.acvd.2016.08.001

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

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. (C) 2016 Elsevier Masson SAS. All rights reserved.

引用

页码：641 / 650

页数：10

共 54 条

[1] The Impact of Heart Failure and Left Ventricular Dysfunction in Predicting Stroke, Thromboembolism, and Mortality in Atrial Fibrillation Patients: A Systematic Review [J].