Direct oral anticoagulation (DOAC) was associated with significant inhibition of atherosclerotic plaque burden in patients who underwent repeated computed tomography angiography (CTA) and catheter ablation for atrial fibrillation (AFib), according to results of a study presented Sept. 3 at ESC Congress 2019 and simultaneously published in JACC: Cardiovascular Imaging.

Experimental and clinical data suggest that DOACs may have an inhibitory effect on atherosclerotic plaque. Based on that evidence, this study aimed to evaluate the effect of different oral anticoagulation agents on the progression of atherosclerosis. Consecutive patients who underwent repeated CTA prior to left atrial catheter ablation of AFib between 2006 and 2017 were included.

A total of 161 patients had repeat CTA (mean interval between scans, 3.2 years) and were included in the analysis. The patients were stratified into a DOAC group (n=50), a vitamin K antagonist (VKA) group (n=50) and controls (no anticoagulation or aspirin; n=61). All patients had AFib but no history of coronary artery disease (CAD). For all patients, the AFib rate during CTA was 21.7 percent at baseline and 26.0 percent at follow-up.

Automated lesion analysis demonstrated progression of absolute plaque burden of 66.5±136.7 mm³ in the VKA group and 27.2±73.6 mm³ in controls, compared with inhibition of absolute plaque burden in the DOAC group (7.1±42.1 mm³ (p<0.001). The annual progression of atherosclerosis was 23.2±47.0 mm³ in the VKA group, 12.3±4.3 mm³ in controls and –4.6±22.9 mm³ in the DOAC group (p=0.003). Average plaque thickness increased by 0.5±0.7 mm with VKA and 0.2±0.7 mm in controls, but remained the same at 0.0±0.34 with DOAC.

"In vitro data and clinical trials support the findings of our study – that DOAC might reduce or inhibit progression of CAD. Nevertheless, not every plaque translates into clinical significance and large cohorts will be needed to elaborate the effect of direct anticoagulation on atherosclerosis," concluded the authors.

Keywords: ESC 19, ESC Congress, Anticoagulants, Plaque, Atherosclerotic, Plaque, Amyloid

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