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

Autor:	Becher N; Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, Hamburg 20246, Germany.; German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, Postdamer Str. 58, 10785 Berlin, Germany., Toennis T; Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, Hamburg 20246, Germany.; German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, Postdamer Str. 58, 10785 Berlin, Germany., Bertaglia E; Department of Cardiac, Vascular, Thoracic and Public Health Sciences, Azienda Ospedaliera, Padua, Italy., Blomström-Lundqvist C; Department of Medical Science, Uppsala University, Uppsala, Sweden.; Department of Cardiology, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden., Brandes A; Department of Cardiology, Esbjerg Hospital-University Hospital of Southern Denmark, Esbjerg, Denmark.; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark., Cabanelas N; Cardiology Department, Fernando Fonseca Hospital, Amadora, Portugal., Calvert M; Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, UK.; NIHR Birmingham Biomedical Research Centre and NIHR Applied Research Collaboration West Midlands, University of Birmingham, Edgbaston, Birmingham, UK., Camm AJ; Cardiovascular and Cell Sciences Research Institute, St George's, University of London, and Imperial College, London, UK., Chlouverakis G; Biostatistics Lab, School of Medicine, University of Crete, Crete, Greece., Dan GA; Medicine University 'Carol Davila', Colentina University Hospital, Bucharest, Romania., Dichtl W; Department of Internal Medicine III, Cardiology and Angiology, Innsbruck Medical University, Innsbruck, Austria., Diener HC; Department of Neuroepidemiology, Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), University Duisburg-Essen, Essen, Germany., Fierenz A; Institute of Medical Biometry and Epidemiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany., Goette A; Department of Cardiology and Intensive Care Medicine, St Vincenz-Hospital Paderborn, Paderborn, Germany.; Atrial Fibrillation NETwork (AFNET), Mendelstrasse 11, 48149 Muenster, Germany., de Groot JR; Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands., Hermans ANL; Departments of Cardiology and Physiology, Maastricht University, Maastricht, The Netherlands., Lip GYH; Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK.; Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark., Lubinski A; Department of Cardiology and Internal Diseases, Medical University of Gdańsk, Gdańsk, Poland., Marijon E; Cardiology Division, European Georges Pompidou Hospital, Paris, France., Merkely B; Heart and Vascular Centre, Semmelweis University, Budapest, Hungary., Mont L; Hospital Clinic, Universtitat de Barcelona, Catalonia, Barcelona, Spain.; Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Catalonia, Barcelona, Spain.; Centro de Investigacion Biomedica en Red Cardiovascular (CIBERCV), Madrid, Spain., Ozga AK; Institute of Medical Biometry and Epidemiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany., Rajappan K; Cardiac Department, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK., Sarkozy A; HRMC, University Hospital Brussels, VUB, Brussels, Belgium., Scherr D; Department of Cardiology, University Hospital Graz, Graz, Austria., Schnabel RB; Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, Hamburg 20246, Germany.; German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, Postdamer Str. 58, 10785 Berlin, Germany., Schotten U; Atrial Fibrillation NETwork (AFNET), Mendelstrasse 11, 48149 Muenster, Germany.; Departments of Cardiology and Physiology, Maastricht University, Maastricht, The Netherlands., Sehner S; Institute of Medical Biometry and Epidemiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany., Simantirakis E; Department of Cardiology, Heraklion University Hospital, Crete, Greece., Vardas P; Department of Cardiology, Heraklion University Hospital, Crete, Greece.; Biomedical Research Foundation Academy of Athens (BRFAA), Greece and Hygeia Hospitals Group, Athens, Greece., Velchev V; Cardiology Clinic, St.Anna University Hospital, Medical University Sofia, Sofia, Bulgaria., Wichterle D; Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czechia., Zapf A; Institute of Medical Biometry and Epidemiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany., Kirchhof P; Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, Hamburg 20246, Germany.; German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, Postdamer Str. 58, 10785 Berlin, Germany.; Atrial Fibrillation NETwork (AFNET), Mendelstrasse 11, 48149 Muenster, Germany.
Jazyk:	angličtina
Zdroj:	European heart journal [Eur Heart J] 2024 Mar 07; Vol. 45 (10), pp. 837-849.
DOI:	10.1093/eurheartj/ehad771
Abstrakt:	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. (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.)
Databáze:	MEDLINE
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