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European Journal of Medical Research
Published in: European Journal of Medical Research 1/2016

Open Access 01-12-2016 | Research

Incidence of left atrial abnormalities under treatment with dabigatran, rivaroxaban, and vitamin K antagonists

Authors: Stefan Reers, Tolga Agdirlioglu, Michael Kellner, Matthias Borowski, Holger Thiele, Johannes Waltenberger, Michael Reppel

Published in: European Journal of Medical Research | Issue 1/2016

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Abstract

Background

Non-vitamin K antagonist oral anticoagulants (NOACs) such as dabigatran or rivaroxaban are alternatives to vitamin K antagonists (VKAs) for prevention of stroke and systemic embolism in patients with atrial fibrillation (AF) and atrial flutter (AFL). Incidences of risk factors for left atrium (LA) and left atrial appendage (LAA) thrombus formation, such as dense spontaneous echo contrast (SEC), low LAA velocity (LAAV) <20 cm/s under treatment with dabigatran and rivaroxaban in comparison with VKAs are unknown.

Methods

We studied 306 patients with AF (94 %) and AFL (6 %) undergoing transesophageal echocardiography. Patients received VKAs (n = 138), dabigatran (n = 68), or rivaroxaban (n = 100) for at least 3 weeks prior to investigation. Time in therapeutic range was 67 % for VKA. Mean CHADS2 score and CHA2DS2-VASc score were 1.3 and 2.5, respectively. Left atrial abnormality was defined as either dense SEC, low LAAV <20 cm/s, or thrombus.

Results

Any LA abnormality occurred in 9, 3, and 5 % of patients receiving VKA, dabigatran, and rivaroxaban, respectively. The most frequent abnormality was LAA thrombus (VKA: 4 %, dabigatran: 0 %, rivaroxaban: 2 %) and low LAAV of less than 20 cm/s (VKA: 4 %, dabigatran: 1 %, rivaroxaban: 1 %), followed by dense SEC (VKA: 2 %, dabigatran: 1 %, rivaroxaban: 2 %). Results of uni- and multivariate analyses revealed a numerically lower but not significantly different frequency of any LA abnormality under dabigatran (OR 0.4, 95 % Cl 0.08 − 1.88, p = 0.25) and rivaroxaban (OR 0.65, 95 % Cl 0.22 − 1.98, p = 0.45) compared to VKA.

Conclusion

With respect to the incidence of LA abnormalities, dabigatran and rivaroxaban are not inferior to VKA.
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Metadata
Title
Incidence of left atrial abnormalities under treatment with dabigatran, rivaroxaban, and vitamin K antagonists
Authors
Stefan Reers
Tolga Agdirlioglu
Michael Kellner
Matthias Borowski
Holger Thiele
Johannes Waltenberger
Michael Reppel
Publication date
01-12-2016
Publisher
BioMed Central
Published in
European Journal of Medical Research / Issue 1/2016
Electronic ISSN: 2047-783X
DOI
https://doi.org/10.1186/s40001-016-0235-8

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