March 06, 2015
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Intracardiac thrombi rates lower with dabigatran, rivaroxaban, compared with phenprocoumon

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The prevalence of intracardiac thrombi was lower in high-risk patients with atrial fibrillation and flutter treated with direct oral anticoagulants compared with phenprocoumon, according to German researchers.

“This result is in line with clinical efficacy of direct oral anticoagulants for the prevention of [thromboembolism],” Maura M. Zylla, MD, and colleagues wrote in their study, published in the American Journal of Cardiology.

Maura M. Zylla, MD

Maura M. Zylla

Although direct oral anticoagulants are safe and effective for stroke prevention, questions remain about their safety during cardioversion, according to the authors. With the rising frequency in the use of these medications, it is essential to identify thromboembolism risk factors in patients.

In this retrospective study, researchers at Heidelberg University in Germany compared the prevalence of intracardiac thrombi in patients with nonvalvular atrial fibrillation treated with direct oral anticoagulants compared with vitamin K antagonists (VKAs). They analyzed 672 transesophageal echocardiograms performed in 643 patients at the university’s medical center between January 2012 and January 2014.

The researchers divided the patients into 4 groups according to anticoagulation therapy: phenprocoumon (n = 180) (Liquamar, Organon USA Inc.), rivaroxaban (n = 122) (Xarelto, Janssen Pharmaceuticals), dabigatran (n = 79) (Pradaxa, Boehringer Ingelheim) and bridging therapy with low–molecular-weight heparin or unfractionated heparin (n = 287).

Patients in the phenprocoumon group had a 17.8% thrombus rate compared with 3.9% in the direct oral anticoagulant group, the authors wrote. Patients in the bridging therapy group tended to have lower thrombus rates compared with phenprocoumon; however, this did not reach statistical significance.

The researchers performed a subgroup analysis that included only patients receiving phenprocoumon with an international normalized ratio ≥ 2 on the day of the investigation or patients receiving direct oral anticoagulation therapy for ≥ 3 weeks. Intracardiac thrombi rates were significantly higher in the phenprocoumon group (18.3%) compared with dabigatran (0%), rivaroxaban (6.6%) and patients receiving any direct oral anticoagulant (3.8%), the authors wrote.

“Our study provides clinically relevant information as it reflects a typical population of routine tertiary hospital patients presenting with common limitations regarding anticoagulant therapy adherence and management,” the authors concluded. “Lower thrombus rates under oral anticoagulation with direct, non-VKA compounds in the present high-risk patient cohort support recommendations issued by the European Heart Rhythm Association in a recent Practical Guide document.”

Disclosures: The researchers report receiving grants from the German Center for Cardiovascular Research, Germany, and the German Ministry of Education and Research. Please see the full study for a list of all other authors’ relevant financial disclosures.