AHA Scientific Sessions 2022 Update, Part 1

Volume 21, Issue 2

As regular readers of this column will appreciate, I’m partial to providing coverage for major clinical meetings. This past week was the American Heart Association (AHA) Scientific Sessions 2022, and a bevy of interesting studies were published. As there was so much good content presented at the meeting, I’ll be devoting 2 weeks of space in this column to covering the meeting.

Without further ado, let’s jump in.

Another Blow to Direct Oral Anticoagulants

In a recent Talking Therapeutics column, I highlighted a growing list of indications for which warfarin is still preferred over a direct oral anticoagulant (DOAC). The list grew slightly larger with the publication of a meta-analysis that was simultaneously presented at AHA Scientific Sessions 2022. While prior studies had evaluated the risk of DOAC use in patients with antiphospholipid antibody syndrome (APA), this new analysis focused on patients with thrombotic APA.

This study found patients treated with a DOAC had a significantly higher risk of arterial thrombotic events, particularly stroke, compared to patients treated with warfarin. Rates of venous thromboembolic events and bleeding were not different between groups.

Anticoagulation for Outpatient COVID-19 Infection Appears Unnecessary

Several studies have already evaluated the possible benefit of prophylactic anticoagulation for ambulatory patients with mild COVID-19 infections. At the meeting, another trial was presented which demonstrated no benefit of rivaroxaban prophylaxis vs placebo for outpatients with COVID-19 infection.

While this trial was stopped early due to low enrollment, it adds to the preponderance of evidence suggesting these patients should not receive pharmacologic prophylaxis against thromboembolic events.

No Dice for Pemafibrate

Pemafibrate, a selective peroxisome proliferator-activated receptor α modulator, was compared to placebo in the PROMINENT trial, which enrolled patients with type 2 diabetes and hypertriglyceridemia. This trial showed that while pemafibrate lowered triglyceride levels significantly, it failed to impact the rates of major adverse cardiovascular events.

These findings are consistent with other trials of fibrates and niacin, which have all shown these agents provide no benefit to additional triglyceride lowering when it comes to reducing the rate of residual cardiovascular disease in patients with elevated risk.