Non-vitamin K antagonist oral anticoagulants and heart failure.
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 (rivaroxaban, 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.
Department of Cardiology, AP-HP, Pitié-Salpêtrière Hospital, Faculty of Medicine Pierre-et-Marie-Curie, University Paris 6, UMRS Inserm-UPMC 1166 and Institute of Cardiometabolism and Nutrition (ICAN), 75013 Paris, France. Electronic address: richard.isnard@psl.aphp.fr.
Richard
R
Isnard
Department of Cardiology, Inserm U1096, Rouen University Hospital, 76031 Rouen, France.
Fabrice
F
Bauer
Department of Cardiology, Paris Diderot University, Sorbonne Paris Centre, UMRS 942, Lariboisière Hospital, 75013 Paris, France.
Alain
A
Cohen-Solal
UPEC, Mondor Amyloidosis Network, Department of Cardiology, AP-HP, Henri-Mondor Teaching Hospital, Inserm U955, DHU ATVB, 94010 Créteil, France.
Thibaud
T
Damy
Department of Cardiology, Rennes University Hospital, University of Rennes 1, LTSI, Inserm UMR 1099, University of Rennes 1, 35033 Rennes, France.
Erwan
E
Donal
Équipe 7 « Obésité et Insuffisance Cardiaque : Approches Moléculaires et Cliniques », Inserm UMR 1048 - I2MC, Faculty of Medicine, University Paul-Sabatier - Toulouse 3, 31432 Toulouse, France.
Michel
M
Galinier
Department of Cardiology, AP-HP, Georges-Pompidou European Hospital, Paris Descartes University, PRES Paris Cité, 75015 Paris, France.
Albert
A
Hagège
École du Cœur et des Anticoagulants, UTIC, CHR Dubos, 95300 Pontoise, France.
Patrick
P
Jourdain
Department of Cardiology, Rennes University Hospital, CIC-IT, 35033 Rennes, France.
Christophe
C
Leclercq
Department of Cardiology, Caen University Hospital, 14003 Caen, France.
Rémi
R
Sabatier
Department of Cardiology and Vascular Diseases, Inserm UMR 1087, CIC 1413, Nantes University, Institut du Thorax, CHU de Nantes, 44093 Nantes, France.
Jean-Noël
JN
Trochu
Faculty of Medicine Pierre-et-Marie-Curie, University Paris 6, Department of Cardiology, AP-HP, Saint-Antoine Hospital, 75012 Paris, France.
Ariel
A
Cohen
D000284:Administration, Oral; D000925:Anticoagulants / Q000008:administration & dosage*; D006333:Heart Failure / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D013923:Thromboembolism / Q000209:etiology / Q000517:prevention & control*; D014812:Vitamin K / Q000037:antagonists & inhibitors*
D000925:Anticoagulants; D014812:Vitamin K
Accident vasculaire cérébral; Antivitamine K; Atrial fibrillation; Fibrillation atriale; Heart failure; Insuffisance cardiaque; Non-vitamin K antagonist oral anticoagulants; Stroke; Vitamin K antagonists