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 - Blomström-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 - Hermans, Astrid N L
AU - Lip, Gregory Y H
AU - Lubinski, 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 B
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 (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.
AB - 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.
KW - NOAH-AFNET 6
KW - atrial fibrillation
KW - atrial high-rate episodes
KW - stroke
U2 - 10.1093/eurheartj/ehad771
DO - 10.1093/eurheartj/ehad771
M3 - Article
SN - 0195-668X
VL - 45
SP - 837
EP - 849
JO - European Heart Journal
JF - European Heart Journal
IS - 10
M1 - ehad771
ER -