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Anticoagulation with edoxaban in patients with long atrial high-rate episodes ≥24 h
N. Becher, T. Toennis, E. Bertaglia, C. Blomström-Lundqvist, A. Brandes, N. Cabanelas, M. Calvert, AJ. Camm, G. Chlouverakis, GA. Dan, W. Dichtl, HC. Diener, A. Fierenz, A. Goette, JR. de Groot, ANL. Hermans, GYH. Lip, A. Lubinski, E. Marijon, B....
Language English Country England, Great Britain
Document type Journal Article
Grant support
AA/18/2/34218
British Heart Foundation - United Kingdom
European Research Council - International
NLK
Free Medical Journals
from 1996 to 1 year ago
Open Access Digital Library
from 1996-01-01
- MeSH
- Anticoagulants therapeutic use MeSH
- Stroke * etiology prevention & control diagnosis MeSH
- Atrial Fibrillation * complications drug therapy diagnosis MeSH
- Humans MeSH
- Pyridines * MeSH
- Risk Factors MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Heart Atria MeSH
- Thiazoles * MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
BACKGROUND AND AIMS: Patients with long atrial high-rate episodes (AHREs) ≥24 h and stroke risk factors are often treated with anticoagulation for stroke prevention. Anticoagulation has never been compared with no anticoagulation in these patients. METHODS: This secondary pre-specified analysis of the Non-vitamin K antagonist Oral anticoagulants in patients with Atrial High-rate episodes (NOAH-AFNET 6) trial examined interactions between AHRE duration at baseline and anticoagulation with edoxaban compared with placebo in patients with AHRE and stroke risk factors. The primary efficacy outcome was a composite of stroke, systemic embolism, or cardiovascular death. The safety outcome was a composite of major bleeding and death. Key secondary outcomes were components of these outcomes and electrocardiogram (ECG)-diagnosed atrial fibrillation. RESULTS: Median follow-up of 2389 patients with core lab-verified AHRE was 1.8 years. AHRE ≥24 h were present at baseline in 259/2389 patients (11%, 78 ± 7 years old, 28% women, CHA2DS2-VASc 4). Clinical characteristics were not different from patients with shorter AHRE. The primary outcome occurred in 9/132 patients with AHRE ≥24 h (4.3%/patient-year, 2 strokes) treated with anticoagulation and in 14/127 patients treated with placebo (6.9%/patient-year, 2 strokes). Atrial high-rate episode duration did not interact with the efficacy (P-interaction = .65) or safety (P-interaction = .98) of anticoagulation. Analyses including AHRE as a continuous parameter confirmed this. Patients with AHRE ≥24 h developed more ECG-diagnosed atrial fibrillation (17.0%/patient-year) than patients with shorter AHRE (8.2%/patient-year; P < .001). CONCLUSIONS: This hypothesis-generating analysis does not find an interaction between AHRE duration and anticoagulation therapy in patients with device-detected AHRE and stroke risk factors. Further research is needed to identify patients with long AHRE at high stroke risk.
Atrial Fibrillation NETwork Mendelstrasse 11 48149 Muenster Germany
Biomedical Research Foundation Academy of Athens Greece and Hygeia Hospitals Group Athens Greece
Biostatistics Lab School of Medicine University of Crete Crete Greece
Cardiology Clinic St Anna University Hospital Medical University Sofia Sofia Bulgaria
Cardiology Department Fernando Fonseca Hospital Amadora Portugal
Cardiology Division European Georges Pompidou Hospital Paris France
Centro de Investigacion Biomedica en Red Cardiovascular Madrid Spain
Department of Cardiac Vascular Thoracic and Public Health Sciences Azienda Ospedaliera Padua Italy
Department of Cardiology and Intensive Care Medicine St Vincenz Hospital Paderborn Paderborn Germany
Department of Cardiology and Internal Diseases Medical University of Gdańsk Gdańsk Poland
Department of Cardiology Esbjerg Hospital University Hospital of Southern Denmark Esbjerg Denmark
Department of Cardiology Heraklion University Hospital Crete Greece
Department of Cardiology Institute for Clinical and Experimental Medicine Prague Czechia
Department of Cardiology University Hospital Graz Graz Austria
Department of Medical Science Uppsala University Uppsala Sweden
Department of Regional Health Research University of Southern Denmark Odense Denmark
Departments of Cardiology and Physiology Maastricht University Maastricht The Netherlands
Heart and Vascular Centre Semmelweis University Budapest Hungary
Hospital Clinic Universtitat de Barcelona Catalonia Barcelona Spain
HRMC University Hospital Brussels VUB Brussels Belgium
Institut d'Investigacions Biomèdiques August Pi Sunyer Catalonia Barcelona Spain
Medicine University 'Carol Davila' Colentina University Hospital Bucharest Romania
References provided by Crossref.org
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