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Name
Alyssa Burrows

Tue, 11/16/2021 - 22:39

Hi Kyla,

Excellent summary of Dr. Conen's lecture last week! As you mentioned, Dr. Conen is leading clinical trials looking at colchicine and non-vitamin K oral anticoagulants (NOACs) in perioperative (PO) atrial fibrillation (AF). Colchicine, an anti-inflammatory, primarily disrupts tubulin leading to subsequent downregulation of multiple inflammatory pathways and modulation of innate immunity [1]. As you addressed, this drug reduces inflammation and is a known risk factor for hospitalization and AF [2]. NOACs provide more predictable anticoagulant activity than warfarin with a lower risk of major bleeding and prevent stroke, which is also a risk factor in this patient population [3]. A study conducted with administrative data from the province of Québec found that for patients with POAF after noncardiac surgery, oral anticoagulation was not associated with a reduced risk of thromboembolic events (adjusted hazard ratio [aHR], 0.89; 95% confidence interval [CI], 0.73-1.07)[4]. The negative outcome of OACs highlights the critical need for further investigation into NOACs in this space [4].

Another therapy I was interested in that is being investigated is Sodium-glucose co-transporter inhibitors (SGLTi), which have been immensely successful in diabetics and have reduced cardiovascular outcomes, including mortality in several populations; however, their effect on AF remains unclear [5]. This meta-analysis and systemic review of SGLTi found moderate quality evidence to support a lower risk of serious AF events and a reduction in total AF events [5]. Heart failure hospitalizations and cardiovascular death were lower in patients on SGLTi [5]. In my opinion, these positive results warrant the extension of the investigation of this drug in AF to POAF. To your knowledge, are there any other drugs that may be up and coming in this space?

I am looking forward to hearing either your thoughts or anyone else who's interested!

-Alyssa

1. Leung YY, Hui LL, Kraus VB. Colchicine—update on mechanisms of action and therapeutic uses. InSeminars in arthritis and rheumatism 2015 Dec 1 (Vol. 45, No. 3, pp. 341-350). WB Saunders.

2. Benz AP, Aeschbacher S, Krisai P, Moschovitis G, Blum S, Meyre P, Blum MR, Rodondi N, Di Valentino M, Kobza R, De Perna ML. Biomarkers of Inflammation and Risk of Hospitalization for Heart Failure in Patients With Atrial Fibrillation. Journal of the American Heart Association. 2021 Apr 20;10(8):e019168.

3. Fanaroff AC, Ohman EM. Non-Vitamin K Antagonist Oral Anticoagulants in the Treatment of Atrial Fibrillation. Annu Rev Med. 2019 Jan 27;70:61-75. doi: 10.1146/annurev-med-042617-092334. Epub 2018 Nov 26. PMID: 30477393.

4. McIntyre WF, Wang MK, Conen D. Balancing the Risks and Benefits of Oral Anticoagulant Use in Patients With Postoperative Atrial Fibrillation. Canadian Journal of Cardiology. 2021 Jun 1;37(6):938-e11.

5. Pandey AK, Okaj I, Kaur H, Belley‐Cote EP, Wang J, Oraii A, Benz AP, Johnson LS, Young J, Wong JA, Verma S. Sodium‐Glucose Co‐Transporter Inhibitors and Atrial Fibrillation: A Systematic Review and Meta‐Analysis of Randomized Controlled Trials. Journal of the American Heart Association. 2021 Sep 7;10(17):e022222.

Name
Alyssa Burrows

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