CBS 2019
CBSMD教育中心
English

科学研究

科研文章

荐读文献

Raising the Evidentiary Bar for Guideline Recommendations for TAVR: JACC Review Topic of the Week Coronary plaque redistribution after stent implantation is determined by lipid composition: A NIRS-IVUS analysis Quality of Life after Everolimus-Eluting Stents or Bypass Surgery for Treatment of Left Main Disease Ticagrelor Monotherapy Versus Dual-Antiplatelet Therapy After PCI: An Individual Patient-Level Meta-Analysis Successful bailout stenting strategy against lethal coronary dissection involving left main bifurcation Intravascular Ultrasound Parameters Associated With Stent Thrombosis After Drug-Eluting Stent Deployment The impact of intravascular ultrasound guidance during drug eluting stent implantation on angiographic outcomes Criteria for Iron Deficiency in Patients With Heart Failure Contribution of stent underexpansion to recurrence after sirolimus-eluting stent implantation for in-stent restenosis Comparison of inhospital mortality, length of hospitalization, costs, and vascular complications of percutaneous coronary interventions guided by ultrasound versus angiography

Clinical TrialVolume 72, Issue 1, July 2018

JOURNAL:J Am Coll Cardiol. Article Link

Risk of Myocardial Infarction in Anticoagulated Patients With Atrial Fibrillation

C J-Y Lee, TA Gerds, N Carlson et al. Keywords: apixaban; dabigatran; direct oral anticoagulant; rivaroxaban; vitamin K antagonist

Abstract


BACKGROUND - Evidence is conflicting as to the efficacy of direct oral anticoagulation (DOAC) and vitamin K antagonist (VKA) for prevention of myocardial infarction (MI).

OBJECTIVES - This study aimed to investigate the risk of MI associated with the use of apixaban, dabigatran, rivaroxaban, and VKA in patients with atrial fibrillation.

METHODS - Patients with atrial fibrillation were identified using Danish health care registers and stratified by initial oral anticoagulant treatment. Standardized absolute 1-year risks were estimated based on Cox regression for hazard rates of MI hospitalizations and mortality. Reported were absolute risks separately for the oral anticoagulation treatments and standardized to the characteristics of the study population.

RESULTS - Of the 31,739 patients included (median age, 74 years; 47% females), the standardized 1-year risk of MI for VKA was 1.6% (95% confidence interval [CI]: 1.3 to 1.8), apixaban was 1.2% (95% CI: 0.9 to 1.4), dabigatran was 1.2% (95% CI: 1.0 to 1.5), and rivaroxaban was 1.1% (95% CI: 0.8 to 1.3). No significant risk differences were observed in the standardized 1-year risks of MI among the DOACs: dabigatran versus apixaban (0.04%; 95% CI: −0.3 to 0.4), rivaroxaban versus apixaban (0.1%; 95% CI: −0.4 to 0.3), and rivaroxaban versus dabigatran (−0.1%; 95% CI: −0.5 to 0.2). The risk differences for DOACs versus VKA were all significant: −0.4% (95% CI: −0.7 to −0.1) for apixaban, −0.4% (95% CI: −0.7 to −0.03) for dabigatran, and −0.5% (95% CI: −0.8 to −0.2) for rivaroxaban.

CONCLUSIONS - No significant risk differences of MI were found in the direct comparisons of DOACs, and DOACs were all associated with a significant risk reduction of MI compared with VKA.