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

  • Nina Becher (Geteilte/r Erstautor/in)
  • Tobias Toennis (Geteilte/r Erstautor/in)
  • Emanuele Bertaglia
  • Carina Blomstrom Lundqvist
  • Axel Brandes
  • Nuno Cabanelas
  • Melanie Calvert
  • A. John Camm
  • Gregory Chlouverakis
  • Gheorghe-Andrei Dan
  • Wolfgang Dichtl
  • Hans-Christoph Diener
  • Alexander Fierenz
  • Andreas Goette
  • Joris R. de Groot
  • Astrid N L Hermans
  • Gregory Y.H. Lip
  • Andrzej Lubiński
  • Eloi Marijon
  • Béla Merkely
  • Lluís Mont
  • Ann-Kathrin Ozga
  • Kim Rajappan
  • Andrea Sarkozy
  • Daniel Scherr
  • Renate Schnabel
  • Ulrich Schotten
  • Susanne Sehner
  • Emmanuel Simantirakis
  • Panos Vardas
  • Vasil Velchev
  • Dan Wichterle
  • Antonia Zapf
  • Paulus Kirchhof
  • NOAH-AFNET 6 Investigators


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.

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.

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).

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.

Bibliografische Daten

StatusVeröffentlicht - 07.03.2024