![Quantification of Atherosclerotic Plaque Activity and Vascular Inflammation using [18-F] Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography FDG-PET/CT](/_next/image?url=https%3A%2F%2Fcloudfront.jove.com%2FCDNSource%2Fteasers%2F3777.jpg&w=3840&q=50)
Plaque Progression Differences Between Apixaban and Rivaroxaban in Patients With Atrial Fibrillation Measured With
Jairo Aldana-Bitar1, Jeff Moore1, Venkat Sanjay Manubolu1
1Division of Cardiology, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA.
Insights
Direct oral anticoagulants (DOACs) like apixaban and rivaroxaban were studied for their effects on coronary plaque progression in atrial fibrillation patients. Apixaban showed significantly lower calcific plaque progression compared to rivaroxaban over 12 months.
Area of Science:
- Cardiology
- Pharmacology
- Medical Imaging
Background:
- Direct oral anticoagulants (DOACs) are linked to reduced coronary calcification and plaque progression versus warfarin.
- However, the comparative effects of different DOACs on coronary plaque burden remain unclear.
Purpose of the Study:
- To compare the 12-month effects of apixaban and rivaroxaban on coronary plaque characteristics and vascular morphology in patients with nonvalvular atrial fibrillation.
- To investigate differences in plaque quantification and progression using cardiac computed tomography.
Main Methods:
- A post hoc analysis of 2 prospective, randomized trials involving 74 patients with nonvalvular atrial fibrillation.
- Patients received either apixaban (2.5-5 mg BID) or rivaroxaban (20 mg QD).
- Serial cardiac computed tomographic angiography was used to assess changes in percent atheroma volume (PAV), calcified plaque (CP) PAV, noncalcified plaque (NCP) PAV, and positive arterial remodeling (PR) over 52 weeks.
Main Results:
- Both apixaban and rivaroxaban groups showed progression in all plaque types (CP, NCP, LD-NCP) and total plaque PAV over 12 months.
- The apixaban group exhibited significantly lower calcific plaque (CP) PAV progression (0.12% vs. 0.46%, P=0.02) compared to the rivaroxaban group.
- Significant changes in positive remodeling (PR) were observed between the two DOACs (P=0.01), with PR changes remaining statistically significant after propensity score weighting (P=0.04).
Conclusions:
- Both apixaban and rivaroxaban demonstrate plaque progression in patients with atrial fibrillation.
- Apixaban was associated with significantly less calcific plaque progression and showed differences in positive remodeling compared to rivaroxaban.
- These findings suggest differential effects of DOACs on coronary atherosclerosis progression.
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.
More Related Videos
08:02Author Spotlight: Enhanced Quantification of Cardiovascular Calcification Progression for Longitudinal Micro PET/CT Studies in Small Research Animals
Published on: November 15, 2024
23:33The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
Related Concept Videos
01:25Imaging Studies for Cardiovascular System VI: Calcium -Scoring CT
01:28Imaging Studies for Cardiovascular System V: CT
01:30Atherosclerosis I: Introduction
01:18Anticoagulant Drugs: Vitamin K Antagonists and Direct Oral Anticoagulants
Warfarin, a prominent vitamin K antagonist family member, exerts its effect by inhibiting the enzyme VKORC1 (vitamin K epoxide reductase complex 1). By hindering this enzyme, warfarin...
01:20Imaging Studies for Cardiovascular System III: X-Ray
Definition and Purpose
An X-ray, or radiograph, is a non-invasive method that uses ionizing radiation to take images of internal structures. It is mainly used in cardiac imaging to examine the heart, lungs, and major blood vessels, aiming to identify abnormalities in the heart's size, shape, and position, such as heart failure, congenital defects, and vascular...