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Mele M, Mele A, Imbrici P, Samarelli F, Purgatorio R, Dinoi G, Correale M, Nicolotti O, De Luca A, Brunetti ND, Liantonio A, Amoroso N. Pleiotropic Effects of Direct Oral Anticoagulants in Chronic Heart Failure and Atrial Fibrillation: Machine Learning Analysis. Molecules 2024; 29:2651. [PMID: 38893525 PMCID: PMC11174118 DOI: 10.3390/molecules29112651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 05/21/2024] [Accepted: 05/30/2024] [Indexed: 06/21/2024] Open
Abstract
Oral anticoagulant therapy (OAT) for managing atrial fibrillation (AF) encompasses vitamin K antagonists (VKAs, such as warfarin), which was the mainstay of anticoagulation therapy before 2010, and direct-acting oral anticoagulants (DOACs, namely dabigatran etexilate, rivaroxaban, apixaban, edoxaban), approved for the prevention of AF stroke over the last thirteen years. Due to the lower risk of major bleeding associated with DOACs, anticoagulant switching is a common practice in AF patients. Nevertheless, there are issues related to OAT switching that still need to be fully understood, especially for patients in whom AF and heart failure (HF) coexist. Herein, the effective impact of the therapeutic switching from warfarin to DOACs in HF patients with AF, in terms of cardiac remodeling, clinical status, endothelial function and inflammatory biomarkers, was assessed by a machine learning (ML) analysis of a clinical database, which ultimately shed light on the real positive and pleiotropic effects mediated by DOACs in addition to their anticoagulant activity.
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Affiliation(s)
- Marco Mele
- Department of Pharmacy—Drug Sciences, University of Bari, Via Orabona 4, 70125 Bari, Italy; (M.M.); (A.M.); (P.I.); (F.S.); (R.P.); (G.D.); (O.N.); (A.D.L.); (N.A.)
- Department of Cardiology, “Ospedali Riuniti” University Hospital, Viale Pinto 1, 71100 Foggia, Italy;
| | - Antonietta Mele
- Department of Pharmacy—Drug Sciences, University of Bari, Via Orabona 4, 70125 Bari, Italy; (M.M.); (A.M.); (P.I.); (F.S.); (R.P.); (G.D.); (O.N.); (A.D.L.); (N.A.)
| | - Paola Imbrici
- Department of Pharmacy—Drug Sciences, University of Bari, Via Orabona 4, 70125 Bari, Italy; (M.M.); (A.M.); (P.I.); (F.S.); (R.P.); (G.D.); (O.N.); (A.D.L.); (N.A.)
| | - Francesco Samarelli
- Department of Pharmacy—Drug Sciences, University of Bari, Via Orabona 4, 70125 Bari, Italy; (M.M.); (A.M.); (P.I.); (F.S.); (R.P.); (G.D.); (O.N.); (A.D.L.); (N.A.)
| | - Rosa Purgatorio
- Department of Pharmacy—Drug Sciences, University of Bari, Via Orabona 4, 70125 Bari, Italy; (M.M.); (A.M.); (P.I.); (F.S.); (R.P.); (G.D.); (O.N.); (A.D.L.); (N.A.)
| | - Giorgia Dinoi
- Department of Pharmacy—Drug Sciences, University of Bari, Via Orabona 4, 70125 Bari, Italy; (M.M.); (A.M.); (P.I.); (F.S.); (R.P.); (G.D.); (O.N.); (A.D.L.); (N.A.)
| | - Michele Correale
- Department of Cardiology, “Ospedali Riuniti” University Hospital, Viale Pinto 1, 71100 Foggia, Italy;
| | - Orazio Nicolotti
- Department of Pharmacy—Drug Sciences, University of Bari, Via Orabona 4, 70125 Bari, Italy; (M.M.); (A.M.); (P.I.); (F.S.); (R.P.); (G.D.); (O.N.); (A.D.L.); (N.A.)
| | - Annamaria De Luca
- Department of Pharmacy—Drug Sciences, University of Bari, Via Orabona 4, 70125 Bari, Italy; (M.M.); (A.M.); (P.I.); (F.S.); (R.P.); (G.D.); (O.N.); (A.D.L.); (N.A.)
| | - Natale Daniele Brunetti
- Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto 1, 71100 Foggia, Italy;
| | - Antonella Liantonio
- Department of Pharmacy—Drug Sciences, University of Bari, Via Orabona 4, 70125 Bari, Italy; (M.M.); (A.M.); (P.I.); (F.S.); (R.P.); (G.D.); (O.N.); (A.D.L.); (N.A.)
| | - Nicola Amoroso
- Department of Pharmacy—Drug Sciences, University of Bari, Via Orabona 4, 70125 Bari, Italy; (M.M.); (A.M.); (P.I.); (F.S.); (R.P.); (G.D.); (O.N.); (A.D.L.); (N.A.)
- National Institute of Nuclear Physics, Section of Bari, Via Orabona 4, 70125 Bari, Italy
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Barkhudaryan A, Doehner W, Scherbakov N. Ischemic Stroke and Heart Failure: Facts and Numbers. An Update. J Clin Med 2021; 10:jcm10051146. [PMID: 33803423 PMCID: PMC7967189 DOI: 10.3390/jcm10051146] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 02/26/2021] [Accepted: 02/27/2021] [Indexed: 12/22/2022] Open
Abstract
Heart failure (HF) is a severe clinical syndrome accompanied by a number of comorbidities. Ischemic stroke occurs frequently in patients with HF as a complication of the disease. In the present review, we aimed to summarize the current state of research on the role of cardio–cerebral interactions in the prevalence, etiology, and prognosis of both diseases. The main pathophysiological mechanisms underlying the development of stroke in HF and vice versa are discussed. In addition, we reviewed the results of recent clinical trials investigating the prevalence and prevention of stroke in patients with HF.
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Affiliation(s)
- Anush Barkhudaryan
- Department of Cardiology, Clinic of General and Invasive Cardiology, University Hospital No 1, Yerevan State Medical University, Yerevan 0025, Armenia;
- Cardiovascular Research Institute Basel, University Hospital Basel, 4056 Basel, Switzerland
| | - Wolfram Doehner
- BIH Center for Regenerative Therapies (BCRT), Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany;
- Department of Cardiology, Campus Virchow, Charité-Universitätsmedizin Berlin, DZHK (German Center for Cardiovascular Research), Partner Site Berlin, 13353 Berlin, Germany
- Center for Stroke Research Berlin (CSB), Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Nadja Scherbakov
- BIH Center for Regenerative Therapies (BCRT), Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany;
- Department of Cardiology, Campus Virchow, Charité-Universitätsmedizin Berlin, DZHK (German Center for Cardiovascular Research), Partner Site Berlin, 13353 Berlin, Germany
- Center for Stroke Research Berlin (CSB), Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
- Correspondence:
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