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Switch to direct anticoagulants and improved endothelial function in patients with chronic heart failure and atrial

Michele Correale1, Alessandra Leopizzi2, Adriana Mallardi2

  • 1Cardiology Department, Ospedali Riuniti University Hospital, Foggia, Italy.

Thrombosis Research
|July 8, 2020
PubMed

Insights

Switching from warfarin to direct oral anticoagulants (DOACs) improved endothelial function in patients with chronic heart failure and atrial fibrillation. This shift also correlated with reduced C-reactive protein levels, indicating reduced inflammation.

Area of Science:

  • Cardiology
  • Vascular Biology
  • Pharmacology

Background:

  • Chronic heart failure (CHF) and atrial fibrillation (AF) are often associated with endothelial dysfunction (ED).
  • Direct oral anticoagulants (DOACs) are increasingly used for AF anticoagulation, with some studies suggesting improved vascular function compared to warfarin.
  • The impact of switching anticoagulation therapy on endothelial function in CHF patients with AF remains an area of investigation.

Purpose of the Study:

  • To evaluate changes in endothelial function, assessed by flow-mediated dilation (FMD), in patients with CHF and AF who switched from warfarin to DOACs.
  • To explore the relationship between changes in endothelial function and inflammatory markers after switching anticoagulation therapy.

Main Methods:

  • A cohort of 43 outpatients with CHF and AF were assessed for FMD at baseline and after 4 months.
  • Patients were categorized based on their anticoagulant (AC) therapy: those who switched from warfarin to DOACs, those who continued DOACs, and those who continued warfarin.
  • Changes in FMD and C-reactive protein (CRP) levels were compared between groups.

Main Results:

  • Patients who switched from warfarin to DOACs demonstrated a significant improvement in FMD (19.0 ± 6.6% vs 3.8 ± 1.3%, p < 0.0001).
  • In the switched group, C-reactive protein (CRP) levels decreased significantly (1.4 ± 0.5 to 1.0 ± 0.7 mg/dl, p < 0.05).
  • Improvements in FMD were proportional to decreases in CRP levels (r = -0.50, p < 0.05) and remained significant even after multivariable analysis.

Conclusions:

  • Switching from warfarin to DOACs in patients with CHF and AF is associated with improved endothelial function.
  • Changes in endothelial function (FMD) were linked to reductions in the inflammatory marker CRP.
  • These findings suggest a potential vascular benefit of DOACs over warfarin in this patient population.
Abstract

Keywords:
DOACsEndothelial dysfunctionHeart failureInflammation

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