NVAF patients on DOACs at lower stroke risk versus warfarin

Non-valvular atrial fibrillation (NAVF) patients with high risk of gastrointestinal (GI) bleed appear less likely to suffer stroke or systemic embolism (SE) while on non-vitamin K antagonist oral anticoagulants (DOACs) than warfarin, a study suggests.

Published in JAMA Network Open, the study compared stroke and/or SE and major bleeding risk in 381,054 patients who were newly prescribed apixaban, dabigatran, rivaroxaban or warfarin between 2013 and 2015.

It found that apixaban (HR, 0.60; 95% CI, 0.52–0.68), dabigatran (HR, 0.75; 95% CI, 0.64–0.88) and rivaroxaban (HR, 0.79; 95% CI, 0.73-0.86) were associated with lower risk of stroke and/or SE compared with warfarin.

Apixaban (HR, 0.59; 95% CI, 0.56–0.63) and dabigatran (HR, 0.78; 95% CI, 0.70–0.86) were also associated with a lower risk of major bleeding, while rivaroxaban was associated with a higher risk versus warfarin, the authors wrote.

“This is one of the first real-world studies to compare [DOACs] in the patients with NVAF and high risk of GI bleed; the results may help inform decision-making regarding OACs in this high-risk patient population,” they concluded.

Hydroxychloroquine CV risk re-assessed in non-COVID-19 patients

Cardiologists can reasonably continue supporting hydroxychloroquine (HCQ) use in rheumatoid arthritis (RA), with a new study suggesting there is minimal cardiovascular risk in non-COVID-19-affected patients.

American researchers reviewed cardiovascular outcomes in 8,852 US veterans who were newly diagnosed with RA and started on HCQ or nonbiologic disease-modifying antirheumatic drugs (DMARDs) between 2001 and 2017, after observational studies linked an increased risk of cardiovascular events and mortality with HCQ use in hospitalised COVID-19 patients.

The new study identified three long QT syndrome events, 56 arrhythmia-related hospitalisations and 280 all-cause deaths — two, 30 (hazard ratio associated with HCQ: 1.16, 95% CI: 0.68–1.95]) and 144 (HR associated with HCQ: 1.06, 95% CI: 0.84–1.34]) of which were in HCQ patients, respectively — at one year follow-up, the authors wrote in Arthritis & Rheumatology.

“Our findings indicate that the incidence of long QT syndrome and arrhythmia-related hospitalisation is low in patients with RA during the first year after the initiation of HCQ or another non-biologic DMARD,” they wrote.

“We found no evidence that HCQ therapy is associated with a higher risk of adverse cardiovascular events or death.”

Yet, study limitations, including lack of echocardiogram use, a mostly-male population inconsistent with the demographic distribution of RA, and relatively short follow-up time, “should give clinicians pause in their desire to be entirely reassured by the findings,” Associate Professor Candace Feldman and Professor Mark Link wrote in an accompanying commentary.

“Overall, the results of this methodologically rigorous study suggest that HCQ administration among patients with RA is unlikely to be associated with a significant enough risk to dissuade clinicians from continuing to safely prescribe the medication.”

“However, additional studies are essential to guide strategies for monitoring of QTc intervals, and to identify individuals at significantly higher risk of adverse outcomes for whom clinicians may consider avoiding HCQ.”

Cardiologist jailed for child abuse material

A former South Australian cardiologist has been sentenced to spend at least a year in prison after being found guilty of possessing child abuse material.

Andrew Douglas McGavigan of Adelaide was found by police to have found more than 4,000 files of “predominately child abuse material”, the ABC reports.

Adelaide District Court Judge Julie McIntyre did not accept McGavigan’s explanation that he had undiagnosed depression and viewed pornography to alleviate stress and boredom, while he was overworked and suffering sleep deprivation as a cardiologist at Flinders Medical Centre.

She sentenced him to three years and four months in prison, with a non-parole period of 12 months on account of his early guilty plea, good character and remorse.

She noted that two former colleagues had provided character references, describing him as a skilled cardiologist who helped keep the cardiology unit together.

The judge also noted that McGavigan had lost his job, professorial titles and been deregistered as a doctor as a result of being charged with the offences.