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

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.

Bibliografische Daten

OriginalspracheEnglisch
Aufsatznummerehad771
ISSN0195-668X
DOIs
StatusVeröffentlicht - 07.03.2024