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Becher, N; Toennis, T; Bertaglia, E; Blomström-Lundqvist, C; Brandes, A; Cabanelas, N; Calvert, M; Camm, AJ; Chlouverakis, G; Dan, GA; Dichtl, W; Diener, HC; Fierenz, A; Goette, A; de, Groot, JR; Hermans, ANL; Lip, GYH; Lubinski, A; Marijon, E; Merkely, B; Mont, L; Ozga, AK; Rajappan, K; Sarkozy, A; Scherr, D; Schnabel, RB; Schotten, U; Sehner, S; Simantirakis, E; Vardas, P; Velchev, V; Wichterle, D; Zapf, A; Kirchhof, P.
Anticoagulation with edoxaban in patients with long atrial high-rate episodes ≥24 h.
Eur Heart J. 2024; 45(10):837-849 Doi: 10.1093/eurheartj/ehad771 [OPEN ACCESS]
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Co-Autor*innen der Med Uni Graz
Scherr Daniel
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Abstract:
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.

Find related publications in this database (Keywords)
Atrial high-rate episodes
Stroke
Atrial fibrillation
NOAH-AFNET 6
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