{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T19:26:22Z","timestamp":1785439582989,"version":"3.56.0"},"reference-count":42,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2024,6,4]],"date-time":"2024-06-04T00:00:00Z","timestamp":1717459200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"PRIN-MIUR","award":["20202YAY9B_004"],"award-info":[{"award-number":["20202YAY9B_004"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Molecules"],"abstract":"<jats:p>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.<\/jats:p>","DOI":"10.3390\/molecules29112651","type":"journal-article","created":{"date-parts":[[2024,6,4]],"date-time":"2024-06-04T07:39:49Z","timestamp":1717486789000},"page":"2651","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Pleiotropic Effects of Direct Oral Anticoagulants in Chronic Heart Failure and Atrial Fibrillation: Machine Learning Analysis"],"prefix":"10.3390","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7219-5404","authenticated-orcid":false,"given":"Marco","family":"Mele","sequence":"first","affiliation":[{"name":"Department of Pharmacy\u2014Drug Sciences, University of Bari, Via Orabona 4, 70125 Bari, Italy"},{"name":"Department of Cardiology, \u201cOspedali Riuniti\u201d University Hospital, Viale Pinto 1, 71100 Foggia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonietta","family":"Mele","sequence":"additional","affiliation":[{"name":"Department of Pharmacy\u2014Drug Sciences, University of Bari, Via Orabona 4, 70125 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9140-5350","authenticated-orcid":false,"given":"Paola","family":"Imbrici","sequence":"additional","affiliation":[{"name":"Department of Pharmacy\u2014Drug Sciences, University of Bari, Via Orabona 4, 70125 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6753-3528","authenticated-orcid":false,"given":"Francesco","family":"Samarelli","sequence":"additional","affiliation":[{"name":"Department of Pharmacy\u2014Drug Sciences, University of Bari, Via Orabona 4, 70125 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1002-5087","authenticated-orcid":false,"given":"Rosa","family":"Purgatorio","sequence":"additional","affiliation":[{"name":"Department of Pharmacy\u2014Drug Sciences, University of Bari, Via Orabona 4, 70125 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giorgia","family":"Dinoi","sequence":"additional","affiliation":[{"name":"Department of Pharmacy\u2014Drug Sciences, University of Bari, Via Orabona 4, 70125 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7863-253X","authenticated-orcid":false,"given":"Michele","family":"Correale","sequence":"additional","affiliation":[{"name":"Department of Cardiology, \u201cOspedali Riuniti\u201d University Hospital, Viale Pinto 1, 71100 Foggia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6533-5539","authenticated-orcid":false,"given":"Orazio","family":"Nicolotti","sequence":"additional","affiliation":[{"name":"Department of Pharmacy\u2014Drug Sciences, University of Bari, Via Orabona 4, 70125 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5652-7341","authenticated-orcid":false,"given":"Annamaria","family":"De Luca","sequence":"additional","affiliation":[{"name":"Department of Pharmacy\u2014Drug Sciences, University of Bari, Via Orabona 4, 70125 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9610-7408","authenticated-orcid":false,"given":"Natale Daniele","family":"Brunetti","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto 1, 71100 Foggia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonella","family":"Liantonio","sequence":"additional","affiliation":[{"name":"Department of Pharmacy\u2014Drug Sciences, University of Bari, Via Orabona 4, 70125 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0211-0783","authenticated-orcid":false,"given":"Nicola","family":"Amoroso","sequence":"additional","affiliation":[{"name":"Department of Pharmacy\u2014Drug Sciences, University of Bari, Via Orabona 4, 70125 Bari, Italy"},{"name":"National Institute of Nuclear Physics, Section of Bari, Via Orabona 4, 70125 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,6,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1161\/CIRCULATIONAHA.122.057444","article-title":"Management of Atrial Fibrillation across the Spectrum of Heart Failure with Preserved and Reduced Ejection Fraction","volume":"146","author":"Reddy","year":"2022","journal-title":"Circulation"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1161\/CIRCHEARTFAILURE.112.000143","article-title":"Left Ventricular Systolic Dysfunction, Heart Failure, and the Risk of Stroke and Systemic Embolism in Patients with Atrial Fibrillation: Insights from the ARISTOTLE Trial","volume":"6","author":"McMurray","year":"2013","journal-title":"Circ. 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