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; Toennis, Tobias; Bertaglia, Emanuele; Blomstrom Lundqvist, Carina; Brandes, Axel; Cabanelas, Nuno; Calvert, Melanie; Camm, A. John; Chlouverakis, Gregory; Dan, Gheorghe-Andrei; Dichtl, Wolfgang; Diener, Hans-Christoph; Fierenz, Alexander; Goette, Andreas; de Groot, Joris R.; N L Hermans, Astrid ; Lip, Gregory Y.H.; Lubiński, Andrzej; Marijon, Eloi; Merkely, Béla; Mont, Lluís; Ozga, Ann-Kathrin; Rajappan, Kim; Sarkozy, Andrea; Scherr, Daniel; Schnabel, Renate; Schotten, Ulrich; Sehner, Susanne; Simantirakis, Emmanuel; Vardas, Panos; Velchev, Vasil; Wichterle, Dan; Zapf, Antonia; Kirchhof, Paulus; NOAH-AFNET 6 Investigators.
In: EUR HEART J, Vol. 45, No. 10, ehad771, 07.03.2024, p. 837-849.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Anticoagulation with edoxaban in patients with long atrial high-rate episodes ≥24 h
AU - Becher, Nina
AU - Toennis, Tobias
AU - Bertaglia, Emanuele
AU - Blomstrom Lundqvist, Carina
AU - Brandes, Axel
AU - Cabanelas, Nuno
AU - Calvert, Melanie
AU - Camm, A. John
AU - Chlouverakis, Gregory
AU - Dan, Gheorghe-Andrei
AU - Dichtl, Wolfgang
AU - Diener, Hans-Christoph
AU - Fierenz, Alexander
AU - Goette, Andreas
AU - de Groot, Joris R.
AU - N L Hermans, Astrid
AU - Lip, Gregory Y.H.
AU - Lubiński, Andrzej
AU - Marijon, Eloi
AU - Merkely, Béla
AU - Mont, Lluís
AU - Ozga, Ann-Kathrin
AU - Rajappan, Kim
AU - Sarkozy, Andrea
AU - Scherr, Daniel
AU - Schnabel, Renate
AU - Schotten, Ulrich
AU - Sehner, Susanne
AU - Simantirakis, Emmanuel
AU - Vardas, Panos
AU - Velchev, Vasil
AU - Wichterle, Dan
AU - Zapf, Antonia
AU - Kirchhof, Paulus
AU - NOAH-AFNET 6 Investigators
PY - 2024/3/7
Y1 - 2024/3/7
N2 - 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.
AB - 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.
U2 - https://doi.org/10.1093/eurheartj/ehad771
DO - https://doi.org/10.1093/eurheartj/ehad771
M3 - SCORING: Journal article
C2 - 37956458
VL - 45
SP - 837
EP - 849
JO - EUR HEART J
JF - EUR HEART J
SN - 0195-668X
IS - 10
M1 - ehad771
ER -