Becher, N;
Toennis, T;
Bertaglia, E;
Blomström-Lundqvist, C;
Brandes, A;
Cabanelas, N;
Calvert, M;
Camm, AJ;
Chlouverakis, G;
Dan, G-A;
et al.
Becher, N; Toennis, T; Bertaglia, E; Blomström-Lundqvist, C; Brandes, A; Cabanelas, N; Calvert, M; Camm, AJ; Chlouverakis, G; Dan, G-A; Dichtl, W; Diener, HC; Fierenz, A; Goette, A; de Groot, JR; Hermans, ANL; Lip, GYH; Lubinski, A; Marijon, E; Merkely, B; Mont, L; Ozga, A-K; Rajappan, K; Sarkozy, A; Scherr, D; Schnabel, RB; Schotten, U; Sehner, S; Simantirakis, E; Vardas, P; Velchev, V; Wichterle, D; Zapf, A; Kirchhof, P
(2024)
Anticoagulation with edoxaban in patients with long Atrial High-Rate Episodes ≥24 hours.
Eur Heart J, 45 (10).
pp. 837-849.
ISSN 1522-9645
https://doi.org/10.1093/eurheartj/ehad771
SGUL Authors: Camm, Alan John
|
PDF
Published Version
Available under License Creative Commons Attribution Non-commercial. Download (1MB) | Preview |
|
|
PDF (Data Supplement)
Supplemental Material
Download (1MB) | Preview |
|
|
PDF
Accepted Version
Available under License Creative Commons Attribution Non-commercial. Download (1MB) | Preview |
Abstract
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.
Item Type: | Article | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Additional Information: | © The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
Keywords: | NOAH-AFNET 6, atrial fibrillation, atrial high-rate episodes, stroke, Atrial high-rate episodes, Stroke, Atrial fibrillation, NOAH-AFNET 6, atrial fibrillation, atrial high-rate episodes, NOAH-AFNET 6, stroke, 1102 Cardiorespiratory Medicine and Haematology, 1103 Clinical Sciences, Cardiovascular System & Hematology | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
Journal or Publication Title: | Eur Heart J | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
ISSN: | 1522-9645 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
Language: | eng | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
Publisher License: | Creative Commons: Attribution-Noncommercial 4.0 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
Projects: |
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||
PubMed ID: | 37956458 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
Web of Science ID: | WOS:001172582000001 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
Go to PubMed abstract | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
URI: | https://openaccess.sgul.ac.uk/id/eprint/115972 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
Publisher's version: | https://doi.org/10.1093/eurheartj/ehad771 |
Statistics
Actions (login required)
![]() |
Edit Item |