title: Evaluation of the vascular protective effects of new oral anticoagulants in high-risk patients with atrial fibrillation (PREFER-AF): study protocol for a randomized controlled trial.
abstract: Atrial fibrillation (AF) is known to be associated with several pathophysiological mechanisms including endothelial dysfunction of the heart and arterial vessels. Recent evidence suggests that new oral anticoagulant (NOAC) treatment may improve endothelial function and the inflammatory process involved in atherosclerosis in AF patients. This study is designed to determine the efficacy of NOAC therapy in the prevention of endothelial dysfunction and the progression of atherosclerosis of AF subjects.
  
  
  
  AF patients with a CHA2DS2-VASc score >2 and no previous history of overt coronary disease, severe peripheral arterial disease (PAD) or major stroke will be registered and randomly assigned either to the NOAC group (dabigatran or rivaroxaban) or the warfarin group in this prospective, randomized, 2-year follow-up study. Reactive hyperemia peripheral arterial tonometry (RH-PAT) measurements reflecting endothelial function will be conducted using the Endo-PAT2000 device. Left and right carotid intima-media thickness (IMT) will be measured at baseline, 12 months, and 24 months. The primary endpoint is defined as change in Reactive Hyperemia Index (RHI) at 12 months. Secondary endpoints included changes in the right and left maximum IMT of the common carotid artery (CCA) and internal carotid artery (ICA), the mean IMT of the CCA and ICA at 24 months, and 24-month cardiovascular events including cardiac death, stroke, acute myocardial infarction (AMI), overall cause of death, withdrawal of drug, or bleeding events.
  
  
  
  This is the first study to evaluate the efficacy of NOAC therapy for the prevention of endothelial dysfunction and progression of atherosclerosis in AF subjects. These findings are expected to expand the knowledge of NOAC pleotropic action in AF patients.
  
  
  
  ClinicalTrials.gov: NCT02544932 , registered on 7 September 2015.
authors: Division of Cardiology, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University, Seoul, Hoegi-dong 1, Dongdaemun-gu, Seoul, 130-701, Republic of Korea.
authors: Jin-Bae
authors: JB
authors: Kim
authors: Division of Cardiology, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University, Seoul, Hoegi-dong 1, Dongdaemun-gu, Seoul, 130-701, Republic of Korea.
authors: Hyun Jun
authors: HJ
authors: Joung
authors: Division of Cardiology, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University, Seoul, Hoegi-dong 1, Dongdaemun-gu, Seoul, 130-701, Republic of Korea.
authors: Jung Myung
authors: JM
authors: Lee
authors: Division of Cardiology, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University, Seoul, Hoegi-dong 1, Dongdaemun-gu, Seoul, 130-701, Republic of Korea.
authors: Jong Shin
authors: JS
authors: Woo
authors: Division of Cardiology, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University, Seoul, Hoegi-dong 1, Dongdaemun-gu, Seoul, 130-701, Republic of Korea.
authors: Woo-Shik
authors: WS
authors: Kim
authors: Division of Cardiology, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University, Seoul, Hoegi-dong 1, Dongdaemun-gu, Seoul, 130-701, Republic of Korea.
authors: Kwon Sam
authors: KS
authors: Kim
authors: Division of Cardiology, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University, Seoul, Hoegi-dong 1, Dongdaemun-gu, Seoul, 130-701, Republic of Korea.
authors: Kyung Hye
authors: KH
authors: Lee
authors: Division of Cardiology, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University, Seoul, Hoegi-dong 1, Dongdaemun-gu, Seoul, 130-701, Republic of Korea. mylovekw@hanmail.net.
authors: Weon
authors: W
authors: Kim
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D050197:Atherosclerosis / Q000517:prevention & control*; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy*; D002985:Clinical Protocols; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies; D018401:Sample Size
chemical_list: D000925:Anticoagulants
keywords: Anticoagulant; Atherosclerosis; Atrial fibrillation; Endothelium