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Published on: February 26, 2013
Pleiotropic Effects of Direct Oral Anticoagulants in Chronic Heart Failure and Atrial Fibrillation: Machine Learning
Marco Mele1,2, Antonietta Mele1, Paola Imbrici1
1Department of Pharmacy-Drug Sciences, University of Bari, Via Orabona 4, 70125 Bari, Italy.
Abstract:
Oral anticoagulant therapy (OAT) for managing atrial fibrillation (AF) encompasses vitamin K antagonists (VKAs, such as warfarin), which was the mainstay of anticoagulation therapy before 2010, and direct-acting oral anticoagulants (DOACs, namely dabigatran etexilate, rivaroxaban, apixaban, edoxaban), approved for the prevention of AF stroke over the last thirteen years. Due to the lower risk of major bleeding associated with DOACs, anticoagulant switching is a common practice in AF patients. Nevertheless, there are issues related to OAT switching that still need to be fully understood, especially for patients in whom AF and heart failure (HF) coexist. Herein, the effective impact of the therapeutic switching from warfarin to DOACs in HF patients with AF, in terms of cardiac remodeling, clinical status, endothelial function and inflammatory biomarkers, was assessed by a machine learning (ML) analysis of a clinical database, which ultimately shed light on the real positive and pleiotropic effects mediated by DOACs in addition to their anticoagulant activity.
Insights
Switching from warfarin to direct-acting oral anticoagulants (DOACs) in atrial fibrillation (AF) patients with heart failure (HF) shows positive effects beyond anticoagulation. Machine learning analysis revealed benefits in cardiac remodeling and inflammatory markers.
Area of Science:
- Cardiology
- Pharmacology
- Data Science
Background:
- Oral anticoagulant therapy (OAT) manages atrial fibrillation (AF) using vitamin K antagonists (VKAs) and direct-acting oral anticoagulants (DOACs).
- DOACs are increasingly used due to a lower risk of major bleeding compared to VKAs.
- Switching OAT is common in AF patients, but understanding its impact in those with coexisting heart failure (HF) is crucial.
Purpose of the Study:
- To assess the impact of switching from warfarin to DOACs in AF patients with HF.
- To evaluate effects on cardiac remodeling, clinical status, endothelial function, and inflammatory biomarkers.
- To identify pleiotropic benefits of DOACs beyond anticoagulation.
Main Methods:
- Machine learning (ML) analysis of a clinical database.
- Retrospective analysis of patient data involving OAT switching.
- Evaluation of cardiac, clinical, endothelial, and inflammatory parameters.
Main Results:
- Therapeutic switching from warfarin to DOACs demonstrated positive effects in AF patients with HF.
- ML analysis identified beneficial impacts on cardiac remodeling and inflammatory biomarkers.
- DOACs exhibited pleiotropic effects beyond their anticoagulant activity.
Conclusions:
- Switching to DOACs in AF patients with HF offers benefits beyond anticoagulation.
- DOACs positively influence cardiac remodeling and inflammatory profiles.
- Further understanding of DOACs' pleiotropic effects is warranted in this patient population.
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