| Autor: |
Becher, Nina, Toennis, Tobias, Bertaglia, Emanuele, Blomström-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, Groot, Joris R de, Hermans, Astrid N L, Lip, Gregory Y H, Lubinski, Andrzej, Marijon, Eloi, Merkely, Béla |
| Předmět: |
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| Zdroj: |
European Heart Journal; 3/7/2024, Vol. 45 Issue 10, p837-849, 13p |
| 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. [ABSTRACT FROM AUTHOR] |
| Databáze: |
Complementary Index |
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