Plaque Progression Differences Between Apixaban and Rivaroxaban in Patients With Atrial Fibrillation Measured With Cardiac Computed Tomography and Plaque Quantification
Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved..
BACKGROUND: Direct oral anticoagulants (DOACs) have been associated with less calcification and coronary plaque progression than warfarin. Whether different DOACs have different effects on coronary plaque burden and progression is not known. We compared the 12-month effects of apixaban and rivaroxaban on plaque characteristics and vascular morphology in patients with atrial fibrillation through quantitative cardiac computed tomographic angiography.
STUDY QUESTION: In patients with nonvalvular atrial fibrillation using apixaban or rivaroxaban, are there differences in plaque quantification and progression measured with cardiac computed tomography?.
STUDY DESIGN: This is a post hoc analysis of 2 paired prospective, single-centered, randomized, open-label trials with blinded adjudication of results. In total, 74 patients were prospectively randomized in parallel trials: 29 to apixaban (2.5-5 mg BID) and 45 to rivaroxaban (20 mg QD). Serial cardiac computed tomographic angiography was performed at baseline and 52 weeks.
MEASURES AND OUTCOMES: Comprehensive whole-heart analysis was performed for differences in the progression of percent atheroma volume (PAV), calcified plaque (CP) PAV, noncalcified plaque (NCP) PAV, positive arterial remodeling (PR) ≥1.10, and high-risk plaque (Cleerly Labs, New York, NY).
RESULTS: Both groups had progression of all 3 plaque types (apixaban: CP 8.7 mm 3 , NCP 69.7 mm 3 , and LD-NCP 27.2 mm 3 ; rivaroxaban: CP 22.9 mm 3 , NCP 66.3 mm 3 , and LD-NCP 11.0 mm 3 ) and a total annual plaque PAV change (apixaban: PAV 1.5%, PAV-CP 0.12%, and PAV-NCP 0.92%; rivaroxaban: PAV 2.1%, PAV-CP 0.46%, and PAV-NCP 1.40%). There was significantly lower PAV-CP progression in the apixaban group compared with the rivaroxaban group (0.12% vs. 0.46% P = 0.02). High-risk plaque characteristics showed a significant change in PR of apixaban versus rivaroxaban ( P = 0.01). When the propensity score weighting model is applied, only PR changes are statistically significant ( P = 0.04).
CONCLUSIONS: In both groups, there is progression of all types of plaque. There was a significant difference between apixaban and rivaroxaban on coronary calcification, with significantly lower calcific plaque progression in the apixaban group, and change in positive remodeling. With weighted modeling, only PR changes are statistically significant between the 2 DOACs.
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2023 |
|---|---|
| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:30 |
|---|---|
| Enthalten in: |
American journal of therapeutics - 30(2023), 4 vom: 01. Juli, Seite e313-e320 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Aldana-Bitar, Jairo [VerfasserIn] |
|---|
| Links: |
|---|
| Themen: |
3Z9Y7UWC1J |
|---|
| Anmerkungen: |
Date Completed 17.07.2023 Date Revised 03.11.2023 published: Print-Electronic ClinicalTrials.gov: NCT00209007, NCT00237601 Citation Status MEDLINE |
|---|
| doi: |
10.1097/MJT.0000000000001569 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM352412380 |
|---|
| LEADER | 01000naa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM352412380 | ||
| 003 | DE-627 | ||
| 005 | 20231226053652.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 231226s2023 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1097/MJT.0000000000001569 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n1174.xml |
| 035 | |a (DE-627)NLM352412380 | ||
| 035 | |a (NLM)36731003 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Aldana-Bitar, Jairo |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Plaque Progression Differences Between Apixaban and Rivaroxaban in Patients With Atrial Fibrillation Measured With Cardiac Computed Tomography and Plaque Quantification |
| 264 | 1 | |c 2023 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 17.07.2023 | ||
| 500 | |a Date Revised 03.11.2023 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a ClinicalTrials.gov: NCT00209007, NCT00237601 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved. | ||
| 520 | |a BACKGROUND: Direct oral anticoagulants (DOACs) have been associated with less calcification and coronary plaque progression than warfarin. Whether different DOACs have different effects on coronary plaque burden and progression is not known. We compared the 12-month effects of apixaban and rivaroxaban on plaque characteristics and vascular morphology in patients with atrial fibrillation through quantitative cardiac computed tomographic angiography | ||
| 520 | |a STUDY QUESTION: In patients with nonvalvular atrial fibrillation using apixaban or rivaroxaban, are there differences in plaque quantification and progression measured with cardiac computed tomography? | ||
| 520 | |a STUDY DESIGN: This is a post hoc analysis of 2 paired prospective, single-centered, randomized, open-label trials with blinded adjudication of results. In total, 74 patients were prospectively randomized in parallel trials: 29 to apixaban (2.5-5 mg BID) and 45 to rivaroxaban (20 mg QD). Serial cardiac computed tomographic angiography was performed at baseline and 52 weeks | ||
| 520 | |a MEASURES AND OUTCOMES: Comprehensive whole-heart analysis was performed for differences in the progression of percent atheroma volume (PAV), calcified plaque (CP) PAV, noncalcified plaque (NCP) PAV, positive arterial remodeling (PR) ≥1.10, and high-risk plaque (Cleerly Labs, New York, NY) | ||
| 520 | |a RESULTS: Both groups had progression of all 3 plaque types (apixaban: CP 8.7 mm 3 , NCP 69.7 mm 3 , and LD-NCP 27.2 mm 3 ; rivaroxaban: CP 22.9 mm 3 , NCP 66.3 mm 3 , and LD-NCP 11.0 mm 3 ) and a total annual plaque PAV change (apixaban: PAV 1.5%, PAV-CP 0.12%, and PAV-NCP 0.92%; rivaroxaban: PAV 2.1%, PAV-CP 0.46%, and PAV-NCP 1.40%). There was significantly lower PAV-CP progression in the apixaban group compared with the rivaroxaban group (0.12% vs. 0.46% P = 0.02). High-risk plaque characteristics showed a significant change in PR of apixaban versus rivaroxaban ( P = 0.01). When the propensity score weighting model is applied, only PR changes are statistically significant ( P = 0.04) | ||
| 520 | |a CONCLUSIONS: In both groups, there is progression of all types of plaque. There was a significant difference between apixaban and rivaroxaban on coronary calcification, with significantly lower calcific plaque progression in the apixaban group, and change in positive remodeling. With weighted modeling, only PR changes are statistically significant between the 2 DOACs | ||
| 650 | 4 | |a Randomized Controlled Trial | |
| 650 | 4 | |a Journal Article | |
| 650 | 7 | |a Rivaroxaban |2 NLM | |
| 650 | 7 | |a 9NDF7JZ4M3 |2 NLM | |
| 650 | 7 | |a apixaban |2 NLM | |
| 650 | 7 | |a 3Z9Y7UWC1J |2 NLM | |
| 650 | 7 | |a Anticoagulants |2 NLM | |
| 650 | 7 | |a Pyridones |2 NLM | |
| 650 | 7 | |a Dabigatran |2 NLM | |
| 650 | 7 | |a I0VM4M70GC |2 NLM | |
| 700 | 1 | |a Moore, Jeff |e verfasserin |4 aut | |
| 700 | 1 | |a Manubolu, Venkat Sanjay |e verfasserin |4 aut | |
| 700 | 1 | |a Dahal, Suraj |e verfasserin |4 aut | |
| 700 | 1 | |a Verghese, Dhiran |e verfasserin |4 aut | |
| 700 | 1 | |a Lakshmanan, Suvasini |e verfasserin |4 aut | |
| 700 | 1 | |a Hussein, Luay |e verfasserin |4 aut | |
| 700 | 1 | |a Crabtree, Tami |e verfasserin |4 aut | |
| 700 | 1 | |a Jonas, Rebecca |e verfasserin |4 aut | |
| 700 | 1 | |a Min, James K |e verfasserin |4 aut | |
| 700 | 1 | |a Earls, James P |e verfasserin |4 aut | |
| 700 | 1 | |a Budoff, Matthew J |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t American journal of therapeutics |d 1994 |g 30(2023), 4 vom: 01. Juli, Seite e313-e320 |w (DE-627)NLM093845677 |x 1536-3686 |7 nnns |
| 773 | 1 | 8 | |g volume:30 |g year:2023 |g number:4 |g day:01 |g month:07 |g pages:e313-e320 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1097/MJT.0000000000001569 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 30 |j 2023 |e 4 |b 01 |c 07 |h e313-e320 | ||