Anticoagulation with edoxaban in patients with long atrial high-rate episodes ≥24 h

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Anticoagulation with edoxaban in patients with long atrial high-rate episodes ≥24 h

Becher, Nina (author): Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, Hamburg, Germany

Toennis, Tobias (author): Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, Hamburg, Germany

Bertaglia, Emanuele (author): Department of Cardiac, Vascular, Thoracic and Public Health Sciences, Azienda Ospedaliera, Padua, Italy

Blomström-Lundqvist, Carina (author): Örebro universitet,Institutionen för medicinska vetenskaper,Department of Medical Science, Uppsala University, Uppsala, Sweden; Department of Cardiology, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden

Brandes, Axel (author): Department of Cardiology, Esbjerg Hospital - University Hospital of Southern Denmark, Esbjerg, and Department of Regional Health Research, University of Southern Denmark, Odense, Denmark

Cabanelas, Nuno (author): Cardiology Department, Fernando Fonseca Hospital, Amadora, Portugal

Calvert, Melanie (author): Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, United Kingdom; NIHR Birmingham Biomedical Research Centre and NIHR Applied Research Collaboration West Midlands, University of Birmingham, Edgbaston, Birmingham, UK

Camm, A. John (author): Cardiovascular and Cell Sciences Research Institute, St George's, University of London, and Imperial College, London, United Kingdom

Chlouverakis, Gregory (author): Biostatistics Lab, School of Medicine, University of Crete, Crete, Greece

Dan, Gheorghe-Andrei (author): Medicine University "Carol Davila", Colentina University Hospital, Bucharest, Romania

Dichtl, Wolfgang (author): Department of Internal Medicine III, Cardiology and Angiology, Innsbruck Medical University, Innsbruck, Austria

Diener, Hans Christoph (author): Department of Neuroepidemiology, Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), University Duisburg-Essen, Essen, Germany

Fierenz, Alexander (author): Institute of Medical Biometry and Epidemiology, University Medical Centre Hamburg-Eppendorf, Germany

Goette, Andreas (author): Department of Cardiology and Intensive Care Medicine, St Vincenz-Hospital Paderborn, Paderborn, Germany; Atrial Fibrillation NETwork (AFNET), Muenster, Germany

de Groot, Joris R. (author): Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands

Hermans, Astrid N. L. (author): Departments of Cardiology and Physiology, Maastricht University, Maastricht, The Netherlands

Lip, Gregory Y. H. (author): Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom; and Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark

Lubinski, Andrzej (author): Medical University of Gdańsk, Department of Cardiology and Internal Diseases, Gdańsk, Poland

Marijon, Eloi (author): Cardiology Division, European Georges Pompidou Hospital, Paris, France

Merkely, Béla (author): Heart and Vascular Centre, Semmelweis University, Budapest, Hungary

Mont, Lluís (author): Hospital Clinic, Universtitat de Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Catalonia, Spain; Centro de Investigacion Biomedica en Red Cardiovascular (CIBERCV), Madrid, Spain

Ozga, Ann-Kathrin (author): Institute of Medical Biometry and Epidemiology, University Medical Centre Hamburg-Eppendorf, Germany

Rajappan, Kim (author): Cardiac Department, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom

Sarkozy, Andrea (author): HRMC, University Hospital Brussels, VUB, Belgium

Scherr, Daniel (author): Department of Cardiology, University Hospital Graz, Austria

Schnabel, Renate B (author): Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, Hamburg, Germany

Schotten, Ulrich (author): Departments of Cardiology and Physiology, Maastricht University, Maastricht, The Netherlands; Atrial Fibrillation NETwork (AFNET), Muenster, Germany

Sehner, Susanne (author): Institute of Medical Biometry and Epidemiology, University Medical Centre Hamburg-Eppendorf, Germany

Simantirakis, Emmanuel (author): Department of Cardiology, Heraklion University Hospital, Heraklion, Crete, Greece

Vardas, Panos (author): Department of Cardiology, Heraklion University Hospital, Heraklion, Crete, Greece; Biomedical Research Foundation Academy of Athens (BRFAA), Greece and Hygeia Hospitals Group, Athens, Greece

Velchev, Vasil (author): Cardiology Clinic, St. Anna University Hospital, Medical University Sofia, Sofia, Bulgaria

Wichterle, Dan (author): Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czechia

Zapf, Antonia (author): Institute of Medical Biometry and Epidemiology, University Medical Centre Hamburg-Eppendorf, Germany

Kirchhof, Paulus (author): Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, Hamburg, Germany; Atrial Fibrillation NETwork (AFNET), Muenster, Germany

NOAH-AFNET, - (contributor)

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Oxford University Press, 2024
2024
English.
In: European Heart Journal. - : Oxford University Press. - 0195-668X .- 1522-9645. ; 45:10, s. 837-849

Related links:: https://doi.org/10.1...; show more...; https://urn.kb.se/re...; https://doi.org/10.1...; show less...

Journal article (peer-reviewed)

Abstract Subject headings

BACKGROUND AND AIMS: Patients with long atrial high-rate episodes (AHRE) ≥ 24 hours and stroke risk factors are often treated with anticoagulation for stroke prevention. Anticoagulation has never been compared to no anticoagulation in these patients.METHODS: This secondary prespecified analysis of NOAH-AFNET 6 examined interactions between AHRE duration at baseline and anticoagulation with edoxaban compared to 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 ECG-diagnosed atrial fibrillation.RESULTS: AHRE ≥24 hours were present at baseline in 259/2389 patients enrolled in NOAH-AFNET 6 (11%, 78 ± 7 years old, 28% women, CHA2DS2-VASc score 4). Clinical characteristics were not different from patients with shorter AHRE. During a median follow-up of 1.8 years, the primary outcome occurred in 9/132 patients with AHRE ≥24 hours (4.3%/patient-year, 2 strokes) treated with anticoagulation and in 14/127 patients treated with placebo (6.9%/patient-year, 2 strokes). AHRE duration did not interact with the efficacy (p-interaction = 0.65) or safety (p-interaction = 0.98) of anticoagulation. Analyses including AHRE as a continuous parameter confirmed this. Patients with AHRE ≥24 hours developed more ECG-diagnosed atrial fibrillation (17.0%/patient-year) than patients with shorter AHRE (8.2%/patient-year; p < 0.001).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.

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MEDICAL AND HEALTH SCIENCES: MEDICAL AND HEAL ...; and Clinical Medicin ...; and Cardiac and Card ...

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Anticoagulation with edoxaban in patients with long atrial high-rate episodes ≥24 h

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