New evidence of direct oral anticoagulation therapy on cardiac valve calcifications, renal preservation and inflammatory modulation.

Abstract

BACKGROUND:

Rivaroxaban is a direct inhibitor of activated Factor X (FXa), an anti-inflammatory protein exerting a protective effect on the cardiac valve and vascular endothelium. We compare the effect of Warfarin and Rivaroxaban on inflammation biomarkers and their contribution to heart valve calcification progression and renal preservation in a population of atrial fibrillation (AF) patients with chronic kidney disease (CKD) stage 3b - 4.

METHODS:

This was an observational, multicenter, prospective study enrolling 347 consecutive CKD stage 3b - 4 patients newly diagnosed with AF: 247 were treated with Rivaroxaban and 100 with Warfarin. Every 12 months, we measured creatinine levels and cardiac valve calcification via standard trans-thoracic echocardiogram, while plasma levels of inflammatory mediators were quantified by ELISA at baseline and after 24 months.

RESULTS:

Over a follow-up of 24 months, long-term treatment with Rivaroxaban was associated with a significative reduction of cytokines. Patients treated with Rivaroxaban experienced a more frequent stabilization/regression of valve calcifications comparing with patients treated with Warfarin. Rivaroxaban use was related with an improvement in kidney function in 87.4% of patients, while in those treated with Warfarin was reported a worsening of renal clearance in 98% of cases. Patients taking Rivaroxaban experienced lower adverse events (3.2% vs 49%, p-value <0.001).

CONCLUSIONS:

Our findings suggest that Rivaroxaban compared to Warfarin is associated with lower levels of serum markers of inflammation. The inhibition of FXa may exert an anti-inflammatory effect contributing to reduce the risk of cardiac valve calcification progression and worsening of renal function.

• Authors: Luca Di Lullo, Carlo Lavalle, Michele Magnocavallo, Marco Valerio Mariani, Domenico Giovanni Della Rocca, Paolo Severino, Biagio Raffaele Di Iorio, Domenico Russo, Francesco Summaria, Giovanni Battista Forleo, Claudio Ronco, Massimo Mancone, Cristina Chimenti, Fabio Miraldi, Andrea Natale, Antonio Bellasi
• Journal: International journal of cardiology (Int J Cardiol) Vol. 345 Pg. 90-97 (Dec 15 2021) ISSN: 1874-1754 [Electronic] Netherlands
• PMID: 34688719 (Publication Type: Journal Article, Multicenter Study, Observational Study)
• Copyright: Copyright © 2021 Elsevier B.V. All rights reserved.

Chemical References

• Anticoagulants
• Factor Xa Inhibitors
• Warfarin
• Rivaroxaban

Topics

• Anticoagulants (adverse effects)
• Atrial Fibrillation
• Calcinosis
• Factor Xa Inhibitors
• Heart Valves (pathology)
• Humans
• Inflammation (drug therapy)
• Kidney (physiology)
• Prospective Studies
• Rivaroxaban
• Stroke
• Treatment Outcome
• Warfarin (adverse effects)