1
|
Dinshaw L, Steffel J, Götte A, Weiss TW, Waltenberger J, Kirchhof P. [Oral anticoagulation with Edoxaban for stroke prevention in patients with atrial fibrillation: Analysis of 1-year follow-up data of routine clinical practice in Germany, Austria and Switzerland (DACH) from the ETNA-AF registry]. Dtsch Med Wochenschr 2024; 149:e58-e66. [PMID: 38959945 PMCID: PMC11251752 DOI: 10.1055/a-2328-7240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2024]
Abstract
Hintergrund Orale Nicht-Vitamin-K-Antikoagulanzien (NOAKs) sind sicher und wirksam in der Schlaganfallprävention bei Patienten mit Vorhofflimmern (AF). Es gibt jedoch nur wenige Daten zur Sicherheit und Wirksamkeit der oralen Antikoagulation mit Edoxaban im deutschsprachigen Raum in der Routineversorgung. Wir berichten über die Ein-Jahres-Ergebnisse der Patienten, die in Deutschland, Österreich und der Schweiz (DACH) im Rahmen der ETNA-AF-Europa-Studie mit Edoxaban zur Schlaganfallprävention behandelt wurden. Methoden Die ETNA-AF-Europa-Studie (Clinicaltrials.gov:NCT02 944 019) ist eine multizentrische, prospektive Beobachtungsstudie, in die mit Edoxaban zur Schlaganfallprävention bei AF behandelte Patienten (n = 13 092) aus 852 Zentren in 10 europäischen Ländern aufgenommen wurden. Die DACH-Kohorte besteht aus 5457 (41,7 %) Patienten aus Zentren in Deutschland, Österreich und der Schweiz. Resultate Die Patienten (74 Jahre, 2384 [44 %] Frauen) hatten im Mittel einen CHA 2 DS 2 -VASc-Score von 3,2 ± 1,4 – und eine labelkonforme Dosierung von Edoxaban wurde von 4309 Patienten (78,9 %) eingenommen. Nach einem Beobachtungszeitraum von einem Jahr traten bei 42 Patienten (0,8 %/Jahr) ein Schlaganfall oder ein systemisch embolisches Ereignis auf, und bei 36 Patienten (0,7 %/Jahr) kam es zu einem schweren Blutungsereignis, was bei 10 Patienten (0,2 %/Jahr) auf eine intrakranielle Blutung und bei 13 Patienten (0,3 %/Jahr) auf eine schwere gastrointestinale (GI) Blutung zurückzuführen war. Schwere und klinisch relevante, nicht schwere Blutungen zusammengenommen ereigneten sich bei insgesamt 72 Patienten (1,4 %/Jahr) über den Beobachtungszeitraum. Die Gesamtmortalität lag bei 179 Patienten (3,4 %/Jahr), wobei 85 (1,6 %/Jahr) an einer kardiovaskulären Todesursache verstarben. Bei Patienten mit einem erhöhten Lebensalter, einem gebrechlichen Allgemeinzustand, einem CHA 2 DS 2 -VASc-Score ≥ 4 zeigten sich eine höhere Gesamtmortalität und eine höhere Rate von Schlaganfällen sowie schweren Blutungsereignissen. Schlussfolgerung In Deutschland, Österreich und der Schweiz ist die Ereignisrate der Schlaganfälle und schweren Blutungen bei Patienten, die zur Schlaganfallprävention bei AF mit Edoxaban behandelt wurden, niedrig. Eine zunehmende Morbidität geht mit einer höheren Rate der relevanten klinischen Endpunkte einher.
Collapse
Affiliation(s)
- Leon Dinshaw
- Universitäres Herz- und Gefäßzentrum UKE Hamburg, Klinik und Poliklinik für Kardiologie, Hamburg
- Sana Hanse-Klinkum Wismar, Klinik für Innere Medizin und Kardiologie, Wismar
| | - Jan Steffel
- Swiss EP AG, Zürich, und Universität Zürich, Schweiz
| | - Andreas Götte
- Medizinische Klinik II, Kardiologie, St. Vincenz-Krankenhaus GmbH, Paderborn
| | - Thomas W. Weiss
- Institut für Kardiometabolik, Karl-Landsteiner-Gesellschaft, St. Pölten und Medizinische Fakultät, Sigmund-Freud-Privatuniversität, Wien
| | | | - Paulus Kirchhof
- Universitäres Herz- und Gefäßzentrum UKE Hamburg, Klinik und Poliklinik für Kardiologie, Hamburg
| |
Collapse
|
2
|
Kirchhof P, Bakhai A, de Asmundis C, de Groot JR, Deharo JC, Kelly P, Lopez-de-Sa E, Monteiro P, Fronk EM, Lamparter M, Laeis P, Smolnik R, Steffel J, Waltenberger J, Weiss TW, De Caterina R. Long-term effectiveness and safety of edoxaban in patients with atrial fibrillation: 4-year data from the ETNA-AF-Europe study. Int J Cardiol 2024; 408:132118. [PMID: 38697397 DOI: 10.1016/j.ijcard.2024.132118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 03/28/2024] [Accepted: 04/29/2024] [Indexed: 05/05/2024]
Abstract
BACKGROUND To assess long-term effectiveness and safety of edoxaban in Europe. METHODS AND RESULTS ETNA-AF-Europe, a prospective, multinational, multi-centre, post-authorisation, observational study was conducted in agreement with the European Medicines Agency. The primary and secondary objectives assessed real-world safety (including bleeding and deaths) and effectiveness (including stroke, systemic embolic events and clinical edoxaban use), respectively. Median (interquartile range) age of the 13,164 patients was 75.0 (68.0-80.0) years; CHA2DS2-VASc and HAS-BLED scores were 3.0 (2.0-4.0) and 2.0 (1.0-2.0), respectively. Follow-up duration was 3.98 (3.21-4.05) years. Patients on edoxaban 30 mg (n = 3042) at baseline were older (80.0 vs 73.0 years), more likely assessed as frail by investigators (27.0% vs 6.6%) and had more comorbidities than those on edoxaban 60 mg (n = 9617; missing dosing information for n = 505). Annualised event rates of all-cause and cardiovascular death in the overall population, edoxaban 60 mg and edoxaban 30 mg groups were 4.1%, 2.8% and 8.4%, and 1.0%, 0.7% and 2.0%, respectively. Annualised rates of stroke were relatively constant throughout the follow-up, transient ischaemic attack and systemic embolism were < 1% in the overall population. Rates of any major and major gastrointestinal bleeding were low, with slightly higher rates for edoxaban 30 vs 60 mg group. Intracranial haemorrhage was uncommon (0.2%). CONCLUSIONS In European patients with AF, long-term therapy with edoxaban is associated with low and relatively constant annualised rates of stroke and major bleeding. Differences in outcomes between the two approved doses are attributable to differences in clinical characteristics.
Collapse
Affiliation(s)
- Paulus Kirchhof
- Institute of Cardiovascular Sciences, University of Birmingham, IBR 136, Wolfson Drive, Birmingham B15 2TT, UK; Department of Cardiology, University Heart and Vascular Centre Hamburg, University Medical Centre Hamburg Eppendorf, Martinistraße 52, Hamburg 20246, Germany; German Center for Cardiovascular Sciences (DZHK), Partner Site Hamburg/Kiel/Lübeck, Germany
| | - Ameet Bakhai
- Department of Cardiology, Royal Free London NHS Foundation Trust, Pond Street, London NW3 2QG, UK
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, Brussels, Belgium
| | - Joris R de Groot
- Amsterdam UMC location University of Amsterdam, Cardiology, Meibergdreef 9, Amsterdam 1105 AZ, the Netherlands; Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Amsterdam 1105 AZ, the Netherlands
| | - Jean Claude Deharo
- AP-HM, Aix Marseille University, Hospital Timone, Cardiologie, Rythmologie, 264 rue Saint-Pierre, Marseille 13005, France
| | - Peter Kelly
- Department of Neurology, HRB Stroke Clinical Trials Network Ireland, University College Dublin/Mater Misericordiae University Hospital, Eccles St, Northside, Dublin, Ireland
| | - Esteban Lopez-de-Sa
- Cardiology Department, Hospital Universitario La Paz, IDIPAZ, Madrid 28046, Spain
| | - Pedro Monteiro
- Department of Cardiology, Centro Hospitalar e Universitario de Coimbra, Praceta Mota Pinto 3000-075, Coimbra, Portugal
| | - Eva-Maria Fronk
- Daiichi Sankyo Europe GmbH, Zielstattstr. 48, Munich 81379, Germany
| | | | - Petra Laeis
- Daiichi Sankyo Europe GmbH, Zielstattstr. 48, Munich 81379, Germany
| | - Rüdiger Smolnik
- Daiichi Sankyo Europe GmbH, Zielstattstr. 48, Munich 81379, Germany
| | | | - Johannes Waltenberger
- Chair of Cardiology and Vascular Medicine, University of Münster, Schlossplatz 2, Münster 48149, Germany; Diagnostic and Therapeutic Heart Center, Kappelistr. 35, Zurich 8002, Switzerland
| | - Thomas W Weiss
- Institute for Cardiometabolic Diseases, Karl Landsteiner Society, St. Polten, Austria
| | - Raffaele De Caterina
- Chair of Cardiology, University of Pisa, and Cardiology Division, Pisa University Hospital, 56124 Pisa, Italy; and Fondazione VillaSerena per la Ricerca, Città Sant'Angelo, Pescara, Italy.
| |
Collapse
|
3
|
Gwechenberger M, Barón-Esquivias G, de Vries TA, Siller-Matula JM, Manu MC, Souza JA, Wienerroither S, Pecen L, de Groot JR, De Caterina R, Kirchhof P. Incidence and Predictors of Worsening Renal Function in Edoxaban-Treated Atrial Fibrillation Patients Within ETNA-AF-Europe Registry. JACC. ADVANCES 2024; 3:100880. [PMID: 38939675 PMCID: PMC11198551 DOI: 10.1016/j.jacadv.2024.100880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 11/27/2023] [Accepted: 12/20/2023] [Indexed: 06/29/2024]
Abstract
Background Managing patients with atrial fibrillation (AF) and worsening renal function (WRF) remains a clinical challenge due to the need of dose adjustment of non-vitamin K antagonist oral anticoagulants. Objectives To determine the incidence of WRF in patients with AF treated with edoxaban, the association of WRF with clinical outcomes, and predictors of WRF and clinical outcomes in these patients. Methods This is a subanalysis of the Edoxaban Treatment in routiNe clinical prActice for patients with non-valvular Atrial Fibrillation in Europe study (NCT02944019), an observational study of edoxaban-treated patients with AF. WRF was defined as a ≥25% reduction in creatinine clearance between baseline and 2 years. Results Of the 9,054 patients included (69% of the total 13,133 enrolled), most did not experience WRF (90.3%) during the first 2 years of follow-up. WRF occurred in 9.7% of patients. Patients with WRF had significantly higher rates of all-cause death (3.88%/y vs 1.88%/y; P < 0.0001), cardiovascular death (2.09%/y vs 0.92%/y; P < 0.0001), and major bleeding (1.51%/y vs 0.98%/y; P = 0.0463) compared with those without WRF. Rates of intracranial hemorrhage (0.18%/y vs 0.18%/y) and of any stroke/systemic embolic events were low (0.90%/y vs 0.69%/y; P = 0.3161) in both subgroups. The strongest predictors of WRF were a high CHA2DS2-VASc score, high baseline creatinine clearance, low body weight, and older age. Most predictors of WRF were also predictors of clinical outcomes. Conclusions WRF occurred in approximately 10% of edoxaban-treated AF patients. Rates of death and major bleeding were significantly higher in patients with WRF than without. Stroke events were low in both subgroups.
Collapse
Affiliation(s)
| | | | - Tim A.C. de Vries
- Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Amsterdam, the Netherlands
- Department of Cardiology, Rijnstate Hospital, Arnhem, the Netherlands
| | | | | | | | | | - Ladislav Pecen
- Institute of Computer Science of the Czech Academy of Sciences, Prague, Czech Republic
- Department of Immunochemistry Diagnostics, University Hospital Pilsen, Pilsen, Czech Republic
| | - Joris R. de Groot
- Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Amsterdam, the Netherlands
| | - Raffaele De Caterina
- Cardiology Division, University of Pisa, Pisa, Italy
- Fondazione VillaSerena per la Ricerca, Pescara, Italy
| | - Paulus Kirchhof
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
- University Heart and Vascular Centre Hamburg, University Medical Centre Hamburg Eppendorf, Hamburg, Germany
- German Center for Cardiovascular Sciences (DZHK) Partner Site Hamburg/Kiel/Lübeck, Hamburg/Kiel/Lübeck, Germany
| | - ETNA-AF-Europe Investigators
- Department of Cardiology, Medical University of Vienna, Vienna, Austria
- Virgen del Rocio University Hospital, University of Seville, Seville, Spain
- Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Amsterdam, the Netherlands
- Department of Cardiology, Rijnstate Hospital, Arnhem, the Netherlands
- Daiichi Sankyo Europe GmbH, Munich, Germany
- Daiichi Sankyo Austria GmbH, Vienna, Austria
- Institute of Computer Science of the Czech Academy of Sciences, Prague, Czech Republic
- Department of Immunochemistry Diagnostics, University Hospital Pilsen, Pilsen, Czech Republic
- Cardiology Division, University of Pisa, Pisa, Italy
- Fondazione VillaSerena per la Ricerca, Pescara, Italy
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
- University Heart and Vascular Centre Hamburg, University Medical Centre Hamburg Eppendorf, Hamburg, Germany
- German Center for Cardiovascular Sciences (DZHK) Partner Site Hamburg/Kiel/Lübeck, Hamburg/Kiel/Lübeck, Germany
| |
Collapse
|
4
|
Cemin R, Cappato R. Lessons derived from post authorisation safety studies (ETNA-AF and XANTUS) on once daily direct oral anticoagulants for atrial fibrillation. Int J Cardiol 2024; 398:131618. [PMID: 38030040 DOI: 10.1016/j.ijcard.2023.131618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/19/2023] [Accepted: 11/23/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Phase III trials should be integrated by post authorisation safety studies (PASS) to confirm their conclusions in real life. In this setting, comorbidities are commonly more prevalent, decisions about drugs and regimens are left to the attending physicians and therapy monitoring is not usually as strict as in pivotal trials. AIMS AND METHODS To evaluate real life safety and effectiveness of edoxaban and rivaroxaban, ETNA-AF Europe (ETNA-AF-Eu) and XANTUS studies were reviewed and compared. A further comparison between data collected in these studies and in the pivotal studies ENGAGE AF-TIMI 48 and ROCKET-AF was also performed. RESULTS ETNA-AF-Eu and XANTUS showed lower bleeding, stroke, cardiovascular- and all-cause mortality rates as compared to those observed in Phase 3 trials, even when including subgroups with lower comorbidities. Patients in ETNA-AF-Eu were older, with a larger proportion of octogenarians (≥85 years in 10.5%) and patients with impaired renal function as compared to patients in XANTUS (CrCl <50 ml/min in 18.2% vs 12.2%) and in ENGAGE AF-TIMI 48 and ROCKET-AF, without paying any excess tribute in terms of safety. Therapy persistence was very high in the two real life studies (91.9% in ETNA-AF-Eu and 79.9% in XANTUS), thus showing that edoxaban and rivaroxaban are well tolerated in real life. CONCLUSION The ETNA-AF-Eu and XANTUS confirmed the safety and effectiveness of edoxaban and rivaroxaban in real life.
Collapse
Affiliation(s)
- Roberto Cemin
- Department of Cardiology, San Maurizio Regional Hospital of Bolzano, Bolzano, Italy.
| | - Riccardo Cappato
- Arrhythmia & Electrophysiology Center, IRCCS Multimedica, Sesto San Giovanni, Milan, Italy
| |
Collapse
|
5
|
Carollo M, Crisafulli S, Ciccimarra F, Andò G, Diemberger I, Trifirò G. Exploring the level of agreement among different drug-drug interaction checkers: a comparative study on direct oral anticoagulants. Expert Opin Drug Metab Toxicol 2024; 20:157-164. [PMID: 38386102 DOI: 10.1080/17425255.2024.2322134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 02/16/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND Direct oral anticoagulants (DOACs) may be involved in drug-drug interactions (DDIs) potentially increasing the risk of adverse drug reactions. This study aimed to evaluate the level of agreement among interaction checkers (ICs) and DOACs' summary of product characteristics (SPCs), in listing DDIs and in attributing DDIs' severity. RESEARCH DESIGN AND METHODS The level of agreement among five ICs (i.e. INTERCheck WEB, Micromedex, Lexicomp, Epocrates, and drugs.com) in identifying potential DDIs and in attributing severity categories was evaluated using Gwet's AC1 on all five ICs and by comparing groups of four- and two-pair sets of ICs. RESULTS A total of 486 potentially interacting drugs with dabigatran, 556 for apixaban, 444 for edoxaban, and 561 for rivaroxaban were reported. The level of agreement among the ICs in identifying potential DDIs was poor (range: 0.12-0.16). Similarly, it was low in 4 and 2 sets analyses. The level of agreement among the ICs in classifying the severity of potential DDIs was poor (range: 0.32-0.34), also in 4 and 2 sets analyses. CONCLUSIONS The heterogeneity among different ICs and SPCs underscores the need to standardize DDI datasets and to conduct real-world studies to generate evidence regarding the frequency and clinical relevance of potential DOAC-related DDIs.
Collapse
Affiliation(s)
- Massimo Carollo
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Salvatore Crisafulli
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Francesco Ciccimarra
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Giuseppe Andò
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Igor Diemberger
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Gianluca Trifirò
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| |
Collapse
|
6
|
Guo X, Du J, Yang Y, Wu M, Ou W, Han X, Wang Z, Jin J, Zhang P, Zhang Z, Chen G, Long M, Yin G, Liu T, Wang X, Li D, Chen M, Dong Y, Lai C, Zhang X, Yi Y, Xiang J, Chen C, Unverdorben M, Ma C. Edoxaban for stroke prevention in atrial fibrillation and factors associated with dosing: patient characteristics from the prospective observational ETNA-AF-China registry. Sci Rep 2024; 14:2778. [PMID: 38307927 PMCID: PMC10837439 DOI: 10.1038/s41598-024-51776-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 01/09/2024] [Indexed: 02/04/2024] Open
Abstract
Real-world data on effectiveness and safety of a single non-vitamin K antagonist oral anticoagulant in the Chinese population with atrial fibrillation (AF) are limited. This study reports characteristics of patients treated with edoxaban and factors associated with dosing patterns from routine care in China. ETNA-AF-China (NCT04747496) is a multicentre, prospective, observational study enrolling edoxaban-treated patients from four economic regions with a targeted 2-year follow-up. Of the 4930 patients with AF (mean age: 70.2 ± 9.5 years; male, 57.1%), the mean creatinine clearance (CrCl), CHA2DS2-VASc, and HAS-BLED scores were 71.2 mL/min, 2.9, and 1.6. Overall, 6.4% of patients were perceived as frail by investigators. Available label dose reduction criteria (N = 4232) revealed that 3278 (77.5%) patients received recommended doses and 954 (22.5%) non-recommended doses. Northeast (53.0%) and West (43.1%) regions had the highest prescriptions of 60 mg and 30 mg recommended doses, respectively. Non-recommended 30 mg doses were more frequently prescribed in patients with antiplatelet use and history of heart failure than recommended 60 mg. Multivariate analysis identified advanced age as the strongest associated factor with non-recommended doses. Frailty had the strongest association with 30 mg except for age, and history of TIA was the most relevant factor associated with 60 mg. In conclusion, patients in the ETNA-AF-China study were predominantly aged 65 years and older, had mild-to-moderate renal impairment and good label adherence. Advanced age was associated with non-recommended doses, with frailty most common for non-recommended 30 mg and a history of TIA for the non-recommended 60 mg dose.
Collapse
Affiliation(s)
- Xueyuan Guo
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China
| | - Juan Du
- Medical Department, Daiichi Sankyo (China) Holdings Co., Ltd, Shanghai, 200040, China
| | - Yang Yang
- Department of Cardiology, The Second Affiliated Hospital of Shenyang Medical College, Shenyang, 110004, Liaoning, China
| | - Mingxing Wu
- Department of Cardiology, Xiangtan Central Hospital, Xiangtan, 411199, Hunan, China
| | - Wenchao Ou
- Department of Cardiology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510260, Guangdong, China
| | - Xuebin Han
- Department of Cardiology, Shanxi Cardiovascular Hospital, Taiyuan, 030024, Shanxi, China
| | - Zhifang Wang
- Deparment of Vasculocardiology, Xinxiang Central Hospital, Xinxiang, 453001, Henan, China
| | - Jing Jin
- Department of Cardiology, The Fourth Hospital of Changsha, Changsha, 410006, Hunan, China
| | - Ping Zhang
- Department of Cardiology, Beijing Tsinghua Changgung Hospital, Beijing, 102218, Beijing, China
| | - Zheng Zhang
- Department of Cardiology, QingPu Branch of Zhongshan Hospital Affiliated to Fudan University, Shanghai, 201799, Shanghai, China
| | - Guoqin Chen
- Department of Cardiology, Guangzhou Panyu Central Hospital, Guangzhou, 511486, Guangdong, China
| | - Mingzhi Long
- Department of Cardiology, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, 210003, Jiangsu, China
| | - Guotian Yin
- Department of Cardiology, The Third Affiliated Hospital Of Xinxiang Medical University, Xinxiang, 453699, Henan, China
| | - Tong Liu
- Department of Cardiology, The Second Hospital of Tianjin Medical University, Tianjin, 300211, Tianjin, China
| | - Xiaoyan Wang
- Department of Cardiology, Affiliated Hospital of Jiangnan University, Wuxi, 214125, Jiangsu, China
| | - Dongsheng Li
- Department of Cardiology, Wuhan Third Hospital, Wuhan, 430074, Hubei, China
| | - Manhua Chen
- Department of Cardiology, The Central Hospital of Wuhan, Wuhan, 430014, Hubei, China
| | - Yugang Dong
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, Guangdong, China
| | - Chunlin Lai
- Department of Cardiology, Shanxi Provincial People's Hospital, Taiyuan, 043599, Shanxi, China
| | - Xuelian Zhang
- Department of Cardiology, Jilin Province People's Hospital, Changchun, 130021, Jilin, China
| | - Yuan Yi
- Medical Department, Daiichi Sankyo (China) Holdings Co., Ltd, Shanghai, 200040, China
| | - Jing Xiang
- Medical Department, Daiichi Sankyo (China) Holdings Co., Ltd, Shanghai, 200040, China
| | - Cathy Chen
- Medical Department, Daiichi Sankyo Inc., Basking Ridge, NJ, 07920-2311, USA
| | - Martin Unverdorben
- Medical Department, Daiichi Sankyo Inc., Basking Ridge, NJ, 07920-2311, USA
| | - Changsheng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China.
| |
Collapse
|
7
|
Patti G, Pecen L, Casalnuovo G, Manu MC, Kirchhof P, De Caterina R. Heterogeneity of outcomes within diabetic patients with atrial fibrillation on edoxaban: a sub-analysis from the ETNA-AF Europe registry. Clin Res Cardiol 2023; 112:1517-1528. [PMID: 35976428 PMCID: PMC10584730 DOI: 10.1007/s00392-022-02080-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 08/01/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Recent data have suggested that insulin-requiring diabetes mostly contributes to the overall increase of thromboembolic risk in patients with atrial fibrillation (AF) on warfarin. We evaluated the prognostic role of a different diabetes status on clinical outcome in a large cohort of AF patients treated with edoxaban. METHODS We accessed individual patients' data from the prospective, multicenter, ETNA-AF Europe Registry. We compared the rates of ischemic stroke/transient ischemic attack (TIA)/systemic embolism, myocardial infarction (MI), major bleeding and all-cause death at 2 years according to diabetes status. RESULTS Out of an overall population of 13,133 patients, 2885 had diabetes (22.0%), 605 of whom (21.0%) were on insulin. The yearly incidence of ischemic stroke/TIA/systemic embolism was 0.86% in patients without diabetes, 0.87% in diabetic patients not receiving insulin (p = 0.92 vs no diabetes) and 1.81% in those on insulin (p = 0.002 vs no diabetes; p = 0.014 vs diabetes not on insulin). The annual rates of MI and major bleeding were 0.40%, 0.43%, 1.04% and 0.90%, 1.10% and 1.71%, respectively. All-cause yearly mortality was 3.36%, 5.02% and 8.91%. At multivariate analysis, diabetes on insulin was associated with a higher rate of ischemic stroke/TIA/systemic embolism [adjusted HR 2.20, 95% CI 1.37-3.54, p = 0.0011 vs no diabetes + diabetes not on insulin] and all-cause death [aHR 2.13 (95% CI 1.68-2.68, p < 0.0001 vs no diabetes]. Diabetic patients not on insulin had a higher mortality [aHR 1.32 (1.11-1.57), p = 0.0015], but similar incidence of stroke/TIA/systemic embolism, MI and major bleeding, vs those without diabetes. CONCLUSIONS In a real-world cohort of AF patients on edoxaban, diabetes requiring insulin therapy, rather than the presence of diabetes per se, appears to be an independent factor affecting the occurrence of thromboembolic events during follow-up. Regardless of the diabetes type, diabetic patients had a lower survival compared with those without diabetes.
Collapse
Affiliation(s)
- Giuseppe Patti
- Department of Translational Medicine, Maggiore della Carità Hospital, University of Eastern Piedmont, Via Solaroli 17, 28100, Novara, Italy.
| | - Ladislav Pecen
- Institute of Computer Science of the Czech Academy of Sciences, Prague, Czech Republic
- Medical Faculty, Charles University, Pilsen, Czech Republic
| | | | | | - Paulus Kirchhof
- Department of Cardiology, University Heart and Vascular Centre UKE, Hamburg, Germany
- Institute of Cardiovascular Sciences, University of Birmingham, SWBH and UHB NHS Trusts, Birmingham, UK
- The Atrial Fibrillation NETwork (AFNET, Münster, Germany
| | - Raffaele De Caterina
- University Cardiology Division, Cardiovascular and Thoracic Department, Pisa University Hospital, University of Pisa, Via Paradisa, 2, 56124, Pisa, Italy.
| |
Collapse
|
8
|
Denas G, Zoppellaro G, Granziera S, Pagliani L, Noventa F, Iliceto S, Pengo V. Very Elderly Patients With Atrial Fibrillation Treated With Edoxaban: Impact of Frailty on Outcomes. JACC. ADVANCES 2023; 2:100569. [PMID: 38939480 PMCID: PMC11198574 DOI: 10.1016/j.jacadv.2023.100569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 06/05/2023] [Accepted: 06/24/2023] [Indexed: 06/29/2024]
Abstract
Background Age and frailty are associated with underuse of anticoagulation in elderly patients with atrial fibrillation (AF). Objectives This study aimed at assessing major clinical outcomes in very elderly patients with AF treated with recommended dose edoxaban and look for a possible relation with frailty measured by a validated score. Methods This prospective multicenter cohort study enrolled consecutive very elderly (age ≥80 years) anticoagulation-naïve patients starting recommended doses of edoxaban. Upon entry into the study, patients were categorized into nonfrail, prefrail and frail with the SHARE-FI (Survey of Health, Ageing, and Retirement in Europe-Frailty Index) score. The primary outcome was a composite incidence of stroke/systemic embolism, major bleeding, clinically relevant nonmajor bleeding, and death between frail and fitter patients over 2 years follow-up. Secondary outcomes were frailty-related incidence of the individual components part of the composite outcome. Results Of the 180 screened patients, 176 were enrolled in the study. Of these, 58 (32.9%) were frail, 35 (19.8%) prefrail, and 83 (47.2%) nonfrail. The composite outcome occurred in 49 patients (18.9% per patient-year). No difference in the primary endpoint between frail and fitter patients (incidence rate ratio: 1.2; 95% CI: 0.6-2.2) was observed. On multivariable analysis, anemia was significantly related to the primary outcome (HR: 3.6; 95% CI: 1.8-7.3; P < 0.001), while frailty was not (frail vs nonfrail HR: 0.9; 95% CI: 0.5-1.8). No difference across frailty categories of the individual components of composite events was observed, except for death. Conclusions Anticoagulation with recommended dose edoxaban is feasible in very elderly patients with AF even if frail. (ESCAPE [Edoxaban and Frailty in Senior Individuals]; NCT03524924).
Collapse
Affiliation(s)
- Gentian Denas
- Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, Cardiology Clinic, University of Padua, Padua, Italy
- Cardiology Unit, High Specialization Rehabilitation Hospital, Treviso, Italy
| | | | - Serena Granziera
- Department of Physical and Rehabilitation Medicine, “Villa Salus” Hospital, Mestre, Italy
| | - Leopoldo Pagliani
- Cardiology Unit, High Specialization Rehabilitation Hospital, Treviso, Italy
| | | | - Sabino Iliceto
- Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, Cardiology Clinic, University of Padua, Padua, Italy
| | - Vittorio Pengo
- Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, Cardiology Clinic, University of Padua, Padua, Italy
| |
Collapse
|
9
|
Adelakun AR, Turgeon RD, De Vera MA, McGrail K, Loewen PS. Oral anticoagulant switching in patients with atrial fibrillation: a scoping review. BMJ Open 2023; 13:e071907. [PMID: 37185198 PMCID: PMC10151984 DOI: 10.1136/bmjopen-2023-071907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/17/2023] Open
Abstract
INTRODUCTION Oral anticoagulants (OACs) prevent stroke in patients with atrial fibrillation (AF). Several factors may cause OAC switching. OBJECTIVES To examine the phenomenon of OAC switching in patients with AF, including all available evidence; frequency and patterns of switch, clinical outcomes, adherence, patient-reported outcomes, reasons for switch, factors associated with switch and evidence gaps. DESIGN Scoping review. DATA SOURCES MEDLINE, Embase and Web of Science, up to January 2022. RESULTS Of the 116 included studies, 2/3 examined vitamin K antagonist (VKA) to direct-acting OAC (DOAC) switching. Overall, OAC switching was common and the definition of an OAC switch varied across. Switching from VKA to dabigatran was the most prevalent switch type, but VKA to apixaban has increased in recent years. Patients on DOAC switched more to warfarin than to other DOACs. OAC doses involved in the switches were hardly reported and patients were often censored after the first switch. Switching back to a previously taken OAC (frequently warfarin) occurred in 5%-21% of switchers.The risk of ischaemic stroke and gastrointestinal bleeding in VKA to DOAC switchers compared with non-switchers was conflicting, while there was no difference in the risk of other types of bleeding. The risk of ischaemic stroke in switchers from DOAC versus non-switchers was conflicting. Studies evaluating adherence found no significant changes in adherence after switching from VKA to DOAC, however, an increase in satisfaction with therapy were reported. Reasons for OAC switch, and factors associated with OAC switch were mostly risk factors for stroke and bleeding. Clinical outcomes, adherence and patient-reported outcomes were sparse for switches from DOACs. CONCLUSIONS OAC switching is common in patients with AF and patients often switch back to an OAC they have previously been on. There are aspects of OAC switching that have received little study, especially in switches from DOACs.
Collapse
Affiliation(s)
- Adenike R Adelakun
- Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Science, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Ricky D Turgeon
- Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Science, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Mary A De Vera
- Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Science, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Kimberlyn McGrail
- Centre for Health Services and Policy Research, The University of British Columbia, Vancouver, British Columbia, Canada
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Peter S Loewen
- Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Science, The University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
10
|
Kirchhof P, Pecen L, Bakhai A, de Asmundis C, de Groot JR, Deharo JC, Kelly P, Levy P, Lopez-de-Sa E, Monteiro P, Steffel J, Waltenberger J, Weiss TW, Laeis P, Manu MC, Souza J, De Caterina R. Edoxaban for stroke prevention in atrial fibrillation and age-adjusted predictors of clinical outcomes in routine clinical care. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2022; 9:47-57. [PMID: 35881467 PMCID: PMC9753092 DOI: 10.1093/ehjcvp/pvac042] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 07/11/2022] [Accepted: 07/22/2022] [Indexed: 11/12/2022]
Abstract
AIMS Patients with atrial fibrillation (AF) treated with oral anticoagulation still suffer from cardiovascular complications including cardiovascular death, stroke, and major bleeding. To identify risk factors for predicting stroke and bleeding outcomes in anticoagulated patients, we assessed 2-year outcomes in patients with AF treated with edoxaban in routine care. We also report the age-adjusted risk predictors of clinical outcomes. METHODS AND RESULTS The Edoxaban Treatment in Routine Clinical Practice for Patients With Non-Valvular Atrial Fibrillation (ETNA-AF) Europe (NCT02944019) is a prospective, multi-centre, post-authorisation, observational study with an overall 4-year follow-up conducted in 825 centres enrolling edoxaban-treated patients in 10 European countries. Of the 13 133 patients with AF (mean age: 73.6 ± 9.5 years), 5682 (43.3%) were female. At the 2-year follow-up, 9017/13 133 patients were still on edoxaban; 1830 discontinued treatment including 937 who died (annualised event rate of all-cause death was 3.87%). 518 (2.14%) patients died of cardiovascular causes; 234 (0.97%) experienced major bleeding and 168 (0.70%) experienced stroke or systemic embolic events (SEE). Intracranial haemorrhage was noted in 49 patients (0.20%). History of transient ischaemic attack (TIA) at baseline was the strongest predictor of ischaemic stroke or SEE (Wald χ2: 73.63; P < 0.0001). Low kidney function at baseline was the strongest predictor of major bleeding (Wald χ2: 30.68; P < 0.0001). History of heart failure (HF) was the strongest predictor of all-cause (Wald χ2: 146.99; P < 0.0001) and cardiovascular death (Wald χ2: 100.38; P < 0.0001). CONCLUSION Patients treated with edoxaban in ETNA-AF-Europe reported low 2-year event rates in unselected AF patients. Prior stroke, reduced kidney function, and HF identify patients at high risk of stroke, bleeding and all-cause/cardiovascular death, respectively.
Collapse
Affiliation(s)
- Paulus Kirchhof
- Institute of Cardiovascular Sciences, University of Birmingham, IBR 136, Wolfson Drive, Birmingham B15 2TT, UK,Department of Cardiology, University Heart and Vascular Centre Hamburg, University Medical Centre Hamburg Eppendorf, Martinistraße 52, 20246 Hamburg, Germany,German Center for Cardiovascular Sciences (DZHK), partner site Hamburg/Kiel/Lübeck, Germany
| | - Ladislav Pecen
- Department of Statistical Modelling, Institute of Computer Science of the Czech Academy of Sciences, Pod Vodarenskou vezi 271/2, 182 07 Prague, Czech Republic
| | - Ameet Bakhai
- Department of Cardiology, Royal Free London NHS Foundation Trust, Pond Street, London NW3 2QG, UK
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Jette, Brussels, Belgium
| | - Joris R de Groot
- Amsterdam UMC location University of Amsterdam, Cardiology, Meibergrdreef 9, 1105 AZ Amsterdam, the Netherlands,Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, 1105 AZ Amsterdam, the Netherlands
| | - Jean Claude Deharo
- AP-HM, Aix Marseille University, Hospital Timone, Cardiologie, Rythmologie, 264 rue Saint-Pierre, 13005, Marseille, France
| | - Peter Kelly
- Department of Neurology, HRB Stroke Clinical Trials Network Ireland, University College Dublin/Mater Misericordiae University Hospital, Eccles St, Northside, D07 R2WY Dublin, Ireland
| | - Pierre Levy
- Department of Economics, Universite Paris-Dauphine, PSL Research University, LEDa-LEGOS, 75775 Paris, France
| | - Esteban Lopez-de-Sa
- Cardiological Intensive Care Unit, Cardiology Service, Hospital Universitario La Paz, IDIPAZ, CIBERCV, 28046 Madrid, Spain
| | - Pedro Monteiro
- Department of Cardiology, Centro Hospitalar e Universitario de Coimbra, Praceta Mota Pinto 3000-075 Coimbra, Portugal
| | - Jan Steffel
- Department of Cardiology and Invasive Electrophysiology, Heart Clinic Hirslanden, Witellikerstrasse 40, 8032 Zürich, Switzerland
| | - Johannes Waltenberger
- Chair of Cardiology and Vascular Medicine, University of Munster, Schlossplatz 2, 48149 Munster, Germany,Diagnostic and Therapeutic Heart Center, Kappelistr. 35, 8002 Zurich, Switzerland
| | - Thomas W Weiss
- Institute for Cardiometabolic Diseases, Karl Landsteiner Society, 3100 St. Polten, Austria
| | - Petra Laeis
- Daiichi Sankyo Europe GmbH, Zielstattstr. 48, 81379 Munich, Germany
| | | | - José Souza
- Daiichi Sankyo Europe GmbH, Zielstattstr. 48, 81379 Munich, Germany
| | - Raffaele De Caterina
- Corresponding author: Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa, First Division of Cardiology, Pisa University Hospital, 56124 Pisa, Italy.
| |
Collapse
|
11
|
Diemberger I, Fumagalli S, Mazzone AM, Bakhai A, Reimitz PE, Pecen L, Manu MC, Gordillo de Souza JA, Kirchhof P, De Caterina R. Perceived vs. objective frailty in patients with atrial fibrillation and impact on anticoagulant dosing: an ETNA-AF-Europe sub-analysis. Europace 2022; 24:1404-1411. [PMID: 35512229 PMCID: PMC9559908 DOI: 10.1093/europace/euac004] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Indexed: 11/13/2022] Open
Abstract
AIMS Frailty is common in patients with atrial fibrillation (AF), with possible impact on therapies and outcomes. However, definitions of frailty are variable, and may not overlap with frailty perception among physicians. We evaluated the prevalence of frailty as perceived by enrolling physicians in the Edoxaban Treatment in Routine Clinical Practice for Patients With Non-Valvular AF (ETNA-AF)-Europe registry (NCT02944019), and compared it with an objective frailty assessment. METHODS AND RESULTS ETNA-AF-Europe is a prospective, multi-centre, post-authorization, observational study. There we assessed the presence of frailty according to (i) a binary subjective investigators' judgement and (ii) an objective measure, the Modified Frailty Index. Baseline data on frailty were available in 13 621/13 980 patients. Prevalence of perceived frailty was 10.6%, with high variability among participating countries and healthcare settings (range 5.9-19.6%). Conversely, only 5.0% of patients had objective frailty, with minimal variability (range 4.5-6.7%); and only <1% of patients were identified as frail by both approaches. Compared with non-frailty-perceived, perceived frail patients were older, more frequently female, and with lower body weight; conversely, objectively frail patients had more comorbidities. Non-recommended edoxaban dose regimens were more frequently prescribed in both frail patient categories. CONCLUSIONS Physicians' perception of frailty in AF patients is variable, mainly driven by age, sex, and weight, and quite different compared with the results of an objective frailty assessment. Whatever the approach, frailty appears to be associated with non-recommended anticoagulant dosages. Whether this apparent inappropriateness influences hard outcomes remains to be assessed.
Collapse
Affiliation(s)
- Igor Diemberger
- Department of Experimental, Diagnostic and Specialty Medicine, Institute of Cardiology, University of Bologna, Policlinico S.Orsola-Malpighi, 40138 Bologna, Italy
| | - Stefano Fumagalli
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; and AOU Careggi, Florence, Italy
| | - Anna Maria Mazzone
- Cardiology Department, 'G. Pasquinucci' Heart Hospital, 'G. Monasterio' Foundation, Massa, Italy
| | - Ameet Bakhai
- Royal Free Hospital London NHS Foundation Trust, London, UK.,Cardiology Department, Barnet General Hospital, Thames House, Enfield, UK
| | | | - Ladislav Pecen
- Department of Immunochemistry Diagnostics, Faculty of Medicine in Pilsen of Charles University, Pilsen, Czech Republic
| | | | | | - Paulus Kirchhof
- University Heart and Vascular Center Hamburg, University Medical Center Hamburg Eppendorf, Hamburg, Germany.,German Center for Cardiovascular REserach (DZHK), partner site Hamburg/Kiel/Lübeck, Germany.,Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Raffaele De Caterina
- Department of Surgical, Medical and Molecular Pathology and of Critical Sciences, University of Pisa, Pisa, Italy.,Division of Cardiology, Azienda Ospedaliero-Universitaria Pisana, via Paradisa, 2, 56124 Pisa, Italy.,Fondazione VillaSerena per la Ricerca, Città Sant'Angelo-Pescara, Pescara, Italy
| |
Collapse
|
12
|
Guerrero-Márquez FJ, Sainz-Hidalgo I, Cristobo Sainz P, Sigler Vilches I, Avilés Toscano A, Soto-Espinosa de Los Monteros B. [Effectiveness of the EQ-5D and CRES-4 questionnaire for assessing the impact on the quality of life of patients and the level of satisfaction after exchanging dicumarinics for edoxabán: Real-life experience based on a multicentre study]. Med Clin (Barc) 2021; 157:530-534. [PMID: 33059936 DOI: 10.1016/j.medcli.2020.07.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 07/09/2020] [Accepted: 07/15/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVE Atrial fibrillation and anticoagulation decrease the quality of life of patients. The aim of this study is to assess the quality of life and the degree of satisfaction after changing from VKA to edoxaban anticoagulants. MATERIAL AND METHODS Prospective, multicentre study, including 105 patients in dicumarinic anticoagulant treatment replaced by edoxaban. Their quality of life was evaluated before and after using the EQ-5D questionnaire, and the degree of satisfaction with CRES-4 scale. RESULTS Average 75 years, CHA2DS2VASC3,5 and HASBLED2,1; thromboembolic events and clinically relevant bleeding during follow-up <1%. EQ-5D showed a significant overall improvement in the mobility and anxiety parameters (P=.023, 95%CI: .0175-.23; P=.019, 95%CI:=.028-.31). The CRES-4 questionnaire showed satisfaction with the therapist of 95%, a positive impact on life of 73% and a negative impact of 3.8%. The emotional state attributed to the change in treatment improved (41% vs 69.5%, P=.0001). The final score of the CRES-4 weakly correlated with the emotional situation of the EQ-5D questionnaire. CONCLUSIONS The change of anticoagulant for edoxaban improves the quality of life and the degree of patient satisfaction, and the EQ-5D and CRES-4 quality of life questionnaires can be used complementarily.
Collapse
Affiliation(s)
| | - Ignacio Sainz-Hidalgo
- Área del Corazón, Servicio de Cardiología, Hospital Virgen del Rocío, Sevilla, España
| | - Pablo Cristobo Sainz
- Área del Corazón, Servicio de Cardiología, Hospital Virgen del Rocío, Sevilla, España
| | | | - Alberto Avilés Toscano
- Departamento de Cardiología, Servicio de Medicina Interna, Hospital de la Serranía, Ronda, Málaga, España
| | | |
Collapse
|
13
|
Gozzo L, Di Lenarda A, Mammarella F, Olimpieri PP, Cirilli A, Cuomo M, Gulizia MM, Colivicchi F, Murri G, Kunutsor SK, Gabrielli D, Trotta F. Starting dose and dose adjustment of non-vitamin K antagonist oral anticoagulation agents in a nationwide cohort of patients with atrial fibrillation. Sci Rep 2021; 11:20689. [PMID: 34667256 PMCID: PMC8526656 DOI: 10.1038/s41598-021-99818-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 09/06/2021] [Indexed: 11/09/2022] Open
Abstract
This study aims to provide real-world data about starting-dose of NOACs and dose-adjustment in patients with atrial fibrillation (AF). In fact, even if new oral anticoagulation agents (NOACs) have a predictable effect without need for regular monitoring, dose-adjustments should be performed according to the summary of product information and international guidelines. We employed the Italian Medicines Agency monitoring registries comprising data on a nationwide cohort of patients with AF treated with NOACs from 2013 to 2018. Logistic regression analysis was used to evaluate the determinants of dosage choice. During the reference period, treatment was commenced for 866,539 patients. Forty-five percent of the first prescriptions were dispensed at a reduced dose (dabigatran 60.3%, edoxaban 45.2%, apixaban 40.9%, rivaroxaban 37.4%). The prescription of reduced dose was associated with older age, renal disease, bleeding risk and the concomitant use of drugs predisposing to bleeding, but not with CHA2DS2-VASc and HAS-BLED. A relative reduction of the proportion of patients treated with low dosages was evident overtime for dabigatran and rivaroxaban; whereas prescription of low dose apixaban and edoxaban increased progressively among elderly patients. Evidence based on real-world data shows a high frequency of low dose prescriptions of NOACs in AF patients. Except for older age, renal disease, bleeding risk and the concomitant use of drugs predisposing to bleeding, other factors that may determine the choice of reduced dose could not be ascertained. There may be potential under-treatment of AF patients, but further evaluation is warranted.
Collapse
Affiliation(s)
- L Gozzo
- Agenzia Italiana del Farmaco, Rome, Italy
| | - A Di Lenarda
- Cardiovascular Center, University Hospital and Health Services of Trieste, Trieste, Italy.
| | | | | | - A Cirilli
- Agenzia Italiana del Farmaco, Rome, Italy
| | - M Cuomo
- Agenzia Italiana del Farmaco, Rome, Italy
| | - M M Gulizia
- National Reference and High Specialization Hospital "Garibaldi-Nesima" of Catania, Catania, Italy.,Cardiology Division, San Filippo Neri Hospital, Rome, Italy.,Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,Cardiology Division, Hospital "Murri", Fermo, Italy.,Heart Care Foundation, Florence, Italy
| | - F Colivicchi
- Cardiology Division, San Filippo Neri Hospital, Rome, Italy
| | - G Murri
- Agenzia Italiana del Farmaco, Rome, Italy
| | - S K Kunutsor
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - D Gabrielli
- Cardiology Division, Hospital "Murri", Fermo, Italy
| | - F Trotta
- Agenzia Italiana del Farmaco, Rome, Italy
| |
Collapse
|
14
|
Boriani G, De Caterina R, Manu MC, Souza J, Pecen L, Kirchhof P. Impact of Weight on Clinical Outcomes of Edoxaban Therapy in Atrial Fibrillation Patients Included in the ETNA-AF-Europe Registry. J Clin Med 2021; 10:2879. [PMID: 34209595 PMCID: PMC8269173 DOI: 10.3390/jcm10132879] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/11/2021] [Accepted: 06/24/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Extremes of body weight may alter exposure to non-vitamin K antagonist oral anticoagulants and thereby impact clinical outcomes. This ETNA-AF-Europe sub-analysis assessed 1-year outcomes in routine care patients with atrial fibrillation across a range of body weight groups treated with edoxaban. METHODS ETNA-AF-Europe is a multinational, multicentre, observational study conducted in 825 sites in 10 European countries. Overall, 1310, 5565, 4346 and 1446 enrolled patients were categorised into ≤60 kg, >60-≤80 kg (reference weight group), >80-≤100 kg and >100 kg groups. RESULTS Patients weighing ≤60 kg were older, more frail and had a higher CHA2DS2-VASc score vs. the other weight groups. The rates of stroke/systemic embolism, major bleeding and ICH were low at 1 year (0.82, 1.05 and 0.24%/year), with no significant differences among weight groups. The annualised event rates of all-cause death were 3.50%/year in the overall population. After adjustment for eGFR and CHA2DS2-VASc score, the risk of all-cause death was significantly higher in extreme weight groups vs. the reference group. CONCLUSIONS Low rates of stroke and bleeding were reported with edoxaban, independent of weight. The risk of all-cause death was higher in extremes of weight vs. the reference group after adjustment for important risk modifiers, thus no obesity paradox was observed.
Collapse
Affiliation(s)
- Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41100 Modena, Italy
| | - Raffaele De Caterina
- Chair of Cardiology, Cardiology Division, Pisa University Hospital, University of Pisa, Via Paradisa 2, 56124 Pisa, Italy;
- Fondazione Villa Serena per la Ricerca, Città Sant’Angelo, 65013 Pescara, Italy
| | | | - José Souza
- Daiichi Sankyo Europe GmbH, Zielstattstraße 48, 81379 Munich, Germany; (M.C.M.); (J.S.)
| | - Ladislav Pecen
- Institute of Computer Science of the Czech Academy of Sciences, 18207 Prague, Czech Republic;
| | - Paulus Kirchhof
- Department of Cardiology, University Heart and Vascular Centre UKE Hamburg, 20246 Hamburg, Germany;
- Institute of Cardiovascular Sciences, University of Birmingham, SWBH and UHB NHS Trusts, Birmingham B152TT, UK
- The Atrial Fibrillation NETwork (AFNET), 48149 Münster, Germany
| |
Collapse
|
15
|
de Vries TAC, Hemels MEW, Cools F, Crijns HJGM, Yperzeele L, Vanacker P, Blankoff I, Lancellotti P, Mairesse GH, de Veer A, Casado Arroyo R, Catez E, de Pauw M, Vanassche T, de Asmundis C, Kirchhof P, De Caterina R, de Groot JR. Characteristics of patients with atrial fibrillation prescribed edoxaban in Belgium and The Netherlands: insights from the ETNA-AF-Europe study. Acta Cardiol 2021; 76:431-439. [PMID: 33406996 DOI: 10.1080/00015385.2020.1746095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 03/17/2020] [Accepted: 03/18/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Studies on the use of non-vitamin K antagonist oral anticoagulants in unselected patients with atrial fibrillation (AF) show that clinical characteristics and dosing practices differ per region, but lack data on edoxaban. METHODS With data from Edoxaban Treatment in routiNe clinical prActice for patients with AF in Europe (ETNA-AF-Europe), a large prospective observational study, we compared clinical characteristics (including the dose reduction criteria for edoxaban: creatinine clearance 15-50 mL/min, weight ≤60 kg, and/or use of strong p-glycoprotein inhibitors) of patients from Belgium and the Netherlands (BeNe) with those from other European countries (OEC). RESULTS Of all 13,639 patients in ETNA-AF-Europe, 2579 were from BeNe. BeNe patients were younger than OEC patients (mean age: 72.3 vs 73.9 years), and had lower CHA2DS2-VASc (mean: 2.8 vs 3.2) and HAS-BLED scores (mean: 2.4 vs 2.6). Patients from BeNe less often had hypertension (61.6% vs 80.4%), and/or diabetes mellitus (17.3% vs 23.1%) than patients from OEC. Moreover, relatively fewer patients in BeNe were prescribed the reduced dose of 30 mg edoxaban (14.8%) than in OEC (25.4%). Overall, edoxaban was dosed according to label in 83.1% of patients. Yet, 30 mg edoxaban was prescribed in the absence of any dose reduction criteria in 36.9% of 30 mg users (5.5% of all patients) in BeNe compared with 35.5% (9.0% of all patients) in OEC. CONCLUSION There were several notable differences between BeNe and OEC regarding clinical characteristics and dosing practices in patients prescribed edoxaban, which are relevant for the local implementation of dose evaluation and optimisation. TRIAL REGISTRATION NCT02944019; Date of registration: October 24, 2016.
Collapse
Affiliation(s)
- Tim A C de Vries
- Department of Cardiology, Rijnstate Hospital, Arnhem, The Netherlands
- Department of Cardiology, Amsterdam Medical Centres/University of Amsterdam, Amsterdam, The Netherlands
| | - Martin E W Hemels
- Department of Cardiology, Rijnstate Hospital, Arnhem, The Netherlands
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Frank Cools
- Department of Cardiology, General Hospital Klinieken Noord-Antwerpen, Brasschaat, Belgium
| | - Harry J G M Crijns
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Laetitia Yperzeele
- Department of Neurosurgery, University Hospital Antwerp, Antwerp, Belgium
| | - Peter Vanacker
- Department of Neurosurgery, University Hospital Antwerp, Antwerp, Belgium
- Department of Neurology, General Hospital Groeninge, Kortrijk, Belgium
| | - Ivan Blankoff
- Department of Cardiology, Civil Hospital Marie Curie, Charleroi, Belgium
| | | | | | - Anne de Veer
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | | | - Emmanuel Catez
- Department of Cardiology, Brugmann University Hospital, Brussels, Belgium
| | - Michel de Pauw
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Thomas Vanassche
- Department of Cardiology, Leuven University Hospital, Leuven, Belgium
| | - Carlo de Asmundis
- Department of Cardiology, University Hospital Brussels, Brussels, Belgium
| | - Paulus Kirchhof
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
- The Atrial Fibrillation NETwork (AFNET), Münster, Germany
| | | | - Joris R de Groot
- Department of Cardiology, Amsterdam Medical Centres/University of Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
16
|
Shen NN, Zhang C, Hang Y, Li Z, Kong LC, Wang N, Wang JL, Gu ZC. Real-World Prevalence of Direct Oral Anticoagulant Off-Label Doses in Atrial Fibrillation: An Epidemiological Meta-Analysis. Front Pharmacol 2021; 12:581293. [PMID: 34122056 PMCID: PMC8188240 DOI: 10.3389/fphar.2021.581293] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 05/04/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The use of direct oral anticoagulant (DOAC) off-label doses in atrial fibrillation (AF) patients may result in poor clinical outcomes. However, the true prevalence remains scarce. This study aims at estimating the prevalence of DOAC off-label doses in AF patients. Methods: Databases of MEDLINE, EMBASE, and COCHRANE were searched from inception through February 2020 for real-world studies that reported the off-label definition and prevalence data of AF patients using DOACs. The primacy outcomes were the overall prevalence of DOAC off-label doses and the corresponding underdose and overdose. The random-effects model was used for data synthesis. Variations on individual DOAC and different regions were examined by subgroup analyses. Results: A total of 23 studies involving 162,474 AF patients were finally included. The overall prevalence of DOAC off-label doses was 24% (95% CI, 19–28%), with 18% for dabigatran, 27% for rivaroxaban, 24% for apixaban, and 26% for edoxaban. The prevalence of underdosed DOACs was 20% (95% CI, 16–24%) with significant difference among individual anticoagulants (13% for dabigatran, 22% for rivaroxaban, 22% for apixaban, and 18% for edoxaban; Pinteraction=0.02). The prevalence of overdosed DOACs was 5% (95% CI, 3–7%), with the lowest prevalence observed in apixaban (2%). Subgroup analyses by regions demonstrated that the prevalence of DOAC off-label doses was higher in Asia (32%) than in North America (14%) and in Europe (22%), with underdose being predominant. Regardless of different regions, the prevalence of overdose was relatively low (4–6%). Conclusion: This study provides an estimation of DOAC off-label doses in the real-world setting. The prevalence rate of DOAC off-label doses in AF patients was relatively high, with underdose being predominant. Clinicians in Asia preferred to prescribe underdose of DOACs to AF patients. More evidence about the appropriateness of DOAC off-label doses in AF patients is urgently needed. Education programs concerning the appropriate prescription of DOACs within the drug labels and accepted guidelines are necessary to DOAC prescribers to ensure the safety and effectiveness of anticoagulation therapy for patients with AF.
Collapse
Affiliation(s)
- Nan-Nan Shen
- Department of Pharmacy, Affiliated Hospital of Shaoxing University, Shaoxing, China.,Department of Pharmacy, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Chi Zhang
- Department of Pharmacy, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.,School of Medicine, Tongji University, Shanghai, China
| | - Ying Hang
- Department of Emergency, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Zheng Li
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Ling-Cong Kong
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Na Wang
- Department of Pharmacy, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jia-Liang Wang
- Department of Pharmacy, Affiliated Hospital of Shaoxing University, Shaoxing, China
| | - Zhi-Chun Gu
- Department of Pharmacy, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.,Shanghai Anticoagulation Pharmacist Alliance, Shanghai Pharmaceutical Association, Shanghai, China.,Chinese Society of Cardiothoracic and Vascular Anesthesiology, Beijing, China
| |
Collapse
|
17
|
Shen NN, Zhang C, Wang N, Wang JL, Gu ZC, Han H. Effectiveness and Safety of Under or Over-dosing of Direct Oral Anticoagulants in Atrial Fibrillation: A Systematic Review and Meta-analysis of 148909 Patients From 10 Real-World Studies. Front Pharmacol 2021; 12:645479. [PMID: 33815125 PMCID: PMC8012667 DOI: 10.3389/fphar.2021.645479] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 02/05/2021] [Indexed: 11/30/2022] Open
Abstract
Background: In routine clinical practice, non-standard doses of direct oral anticoagulants (DOACs) are commonly used in patients with atrial fibrillation (AF). However, data on the clinical outcomes of non-standard doses of DOACs are limited. Methods: The MEDLINE, Embase, and Cochrane Library databases were systematically searched from their inception until 30 June 2020 for studies that reported the effectiveness or safety outcomes of non-standard doses of DOACs compared with on-label doses of DOACs in patients with atrial fibrillation. Non-standard doses of DOACs were defined as under or over-dose of DOACs based on the recommended standard doses in drug labels. A random-effects meta-analysis was performed to calculate the pooled hazard ratio and associated 95% confidence interval (95% confidence interval). Subgroup analyses were conducted according to individual DOACs and different geographic regions. Results: Ten articles involving 148,909 patients with AF were included. There were no significant differences between under-dosing and on-label dosing with respect to stroke/systematic embolism (HR: 1.01, 95% CI: 0.93–1.09), major bleeding (HR: 0.98, 95% CI: 0.77–1.19), intracranial haemorrhage (HR: 1.07, 95% CI: 0.74–1.40), gastrointestinal bleeding (HR: 1.10, 95% CI: 0.82–1.39), and myocardial infarction (HR: 1.07, 95% CI: 0.89–1.25), except for an increased risk of death (HR: 1.37, 95% CI: 1.01–1.73). We observed a significant association between over-dosing of DOACs and increased risk of stroke/systematic embolism (HR: 1.18, 95% CI: 1.04–1.32), major bleeding (HR: 1.16, 95% CI: 1.03–1.29), and death (HR: 1.21, 95% CI: 1.03–1.38) compared with on-label dosing. Furthermore, over-dosing of DOACs increased the risk of stroke/systematic embolism (HR: 1.16; 95% CI: 1.00–1.33) and major bleeding events (HR: 1.18; 95% CI: 1.00–1.37) in Asian patients. Conclusion: A reduced dose of DOACs might be safely and effectively used in clinical practice, especially in Asian patients, whereas high-dose DOACs might not be well tolerated by Asian patients.
Collapse
Affiliation(s)
- Nan-Nan Shen
- Department of Pharmacy, Affiliated Hospital of Shaoxing University, Shao Xing, China.,Department of Pharmacy, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Chi Zhang
- Department of Pharmacy, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Na Wang
- Department of Pharmacy, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jia-Liang Wang
- Department of Pharmacy, Affiliated Hospital of Shaoxing University, Shao Xing, China
| | - Zhi-Chun Gu
- Department of Pharmacy, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Hua Han
- School of Medicine, Tongji University, Shanghai, China
| |
Collapse
|
18
|
de Vries TAC, Hemels MEW, Cools F, Crijns HJGM, Yperzeele L, Vanacker P, Blankoff I, Lancellotti P, Mairesse GH, de Veer A, Casado Arroyo R, Catez E, de Pauw M, Vanassche T, de Asmundis C, Kirchhof P, De Caterina R, de Groot JR. Characteristics of patients with atrial fibrillation prescribed edoxaban in Belgium and the Netherlands: insights from the ETNA-AF-Europe study. Neth Heart J 2021; 29:158-167. [PMID: 33411231 PMCID: PMC7904979 DOI: 10.1007/s12471-020-01518-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2020] [Indexed: 11/09/2022] Open
Abstract
Background Studies on the use of non-vitamin K antagonist oral anticoagulants in unselected patients with atrial fibrillation (AF) show that clinical characteristics and dosing practices differ per region, but lack data on edoxaban. Methods With data from Edoxaban Treatment in routiNe clinical prActice for patients with AF in Europe (ETNA-AF-Europe), a large prospective observational study, we compared clinical characteristics (including the dose reduction criteria for edoxaban: creatinine clearance 15–50 ml/min, weight ≤60 kg, and/or use of strong p‑glycoprotein inhibitors) of patients from Belgium and the Netherlands (BeNe) with those from other European countries (OEC). Results Of all 13,639 patients in ETNA-AF-Europe, 2579 were from BeNe. BeNe patients were younger than OEC patients (mean age: 72.3 vs 73.9 years), and had lower CHA2DS2-VASc (mean: 2.8 vs 3.2) and HAS-BLED scores (mean: 2.4 vs 2.6). Patients from BeNe less often had hypertension (61.6% vs 80.4%), and/or diabetes mellitus (17.3% vs 23.1%) than patients from OEC. Moreover, relatively fewer patients in BeNe were prescribed the reduced dose of 30 mg edoxaban (14.8%) than in OEC (25.4%). Overall, edoxaban was dosed according to label in 83.1% of patients. Yet, 30 mg edoxaban was prescribed in the absence of any dose reduction criteria in 36.9% of 30 mg users (5.5% of all patients) in BeNe compared with 35.5% (9.0% of all patients) in OEC. Conclusion There were several notable differences between BeNe and OEC regarding clinical characteristics and dosing practices in patients prescribed edoxaban, which are relevant for the local implementation of dose evaluation and optimisation. Trial registration NCT02944019; Date of registration 24 October 2016 Electronic supplementary material The online version of this article (10.1007/s12471-020-01518-7) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- T A C de Vries
- Department of Cardiology, Rijnstate Hospital, Arnhem, The Netherlands. .,Department of Cardiology, Amsterdam Medical Centres/University of Amsterdam, Amsterdam, The Netherlands.
| | - M E W Hemels
- Department of Cardiology, Rijnstate Hospital, Arnhem, The Netherlands.,Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - F Cools
- Department of Cardiology, General Hospital Klinieken Noord-Antwerpen, Brasschaat, Belgium
| | - H J G M Crijns
- Department of Cardiology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - L Yperzeele
- Department of Neurosurgery, University Hospital Antwerp, Antwerp, Belgium
| | - P Vanacker
- Department of Neurosurgery, University Hospital Antwerp, Antwerp, Belgium.,Department of Neurology, General Hospital Groeninge, Kortrijk, Belgium
| | - I Blankoff
- Department of Cardiology, Civil Hospital Marie Curie, Charleroi, Belgium
| | - P Lancellotti
- Department of Cardiology, University Hospital of Liège, Liège, Belgium
| | - G H Mairesse
- Department of Cardiology, Cliniques du Sud-Luxembourg, Arlon, Belgium
| | - A de Veer
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - R Casado Arroyo
- Department of Cardiology, Hospital Erasme, Anderlecht, Belgium
| | - E Catez
- Department of Cardiology, Brugmann University Hospital, Brussels, Belgium
| | - M de Pauw
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium
| | - T Vanassche
- Department of Cardiology, Leuven University Hospital, Leuven, Belgium
| | - C de Asmundis
- Department of Cardiology, University Hospital Brussels, Brussels, Belgium
| | - P Kirchhof
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK.,The Atrial Fibrillation NETwork (AFNET), Münster, Germany
| | - R De Caterina
- Department of Cardiology, University of Pisa, Pisa, Italy
| | - J R de Groot
- Department of Cardiology, Amsterdam Medical Centres/University of Amsterdam, Amsterdam, The Netherlands
| | | |
Collapse
|
19
|
Prevención del ictus en pacientes con fibrilación auricular. Mejorar la protección enla era de la COVID-19. REVISTA ESPAÑOLA DE CARDIOLOGÍA SUPLEMENTOS 2021. [PMCID: PMC8320275 DOI: 10.1016/s1131-3587(21)00002-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
La fibrilación auricular aumenta hasta en 5 veces el riesgo de ictus. Los ictus cardioembólicos habitualmente son más graves y tienen altas tasas de recurrencias y discapacidad permanente en comparación con los ictus de otras etiologías. En consecuencia, la reducción del riesgo de ictus mediante una adecuada anticoagulación es uno de los principales objetivos en el tratamiento de los pacientes con fibrilación auricular. Los antagonistas de la vitamina K han sido ampliamente superados por los anticoagulantes orales de acción directa, ya que tanto los resultados de los ensayos clínicos como los de los estudios de práctica clínica y, últimamente, estudios poblacionales han demostrado que los anticoagulantes orales de acción directa tienen mayores eficacia (menos ictus y muerte) y seguridad (menos hemorragias intracraneales) que los antagonistas de la vitamina K. Además, durante la pandemia de COVID-19, el empleo preferente de anticoagulantes orales de acción directa frente a los antagonistas de la vitamina K constituye una estrategia clave para garantizar una calidad óptima de la anticoagulación y una mejor protección del paciente contra el SARS-CoV-2, al no precisarse control de la razón internacional normalizada.
Collapse
|
20
|
Using machine learning to predict anticoagulation control in atrial fibrillation: A UK Clinical Practice Research Datalink study. INFORMATICS IN MEDICINE UNLOCKED 2021. [DOI: 10.1016/j.imu.2021.100688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
21
|
de Groot JR, Weiss TW, Kelly P, Monteiro P, Deharo JC, de Asmundis C, López-de-Sá E, Waltenberger J, Steffel J, Levy P, Bakhai A, Zierhut W, Laeis P, Manu MC, Reimitz PE, De Caterina R, Kirchhof P. Edoxaban for stroke prevention in atrial fibrillation in routine clinical care: 1-year follow-up of the prospective observational ETNA-AF-Europe study. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2020; 7:f30-f39. [PMID: 32790837 PMCID: PMC8117428 DOI: 10.1093/ehjcvp/pvaa079] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 05/28/2020] [Accepted: 08/05/2020] [Indexed: 01/16/2023]
Abstract
Aims Non-vitamin K oral anticoagulants are safe and effective for stroke prevention in patients with atrial fibrillation (AF). Data on the safety and efficacy of edoxaban in routine care are limited in Europe. We report 1-year outcomes in patients with AF treated with edoxaban in routine care. Methods and results ETNA-AF-Europe is a prospective, multicentre, post-authorization, observational study enrolling patients treated with edoxaban in 10 European countries, the design of which was agreed with the European Medicines Agency as part of edoxaban’s post-approval safety plan. Altogether 13 092 patients in 852 sites completed the 1-year follow-up [mean age: 73.6 ± 9.5 years; 57% male, mean follow-up: 352 ± 49 days (median: 366 days)]. Most patients had associated comorbidities (mean CHA2DS2-VASc score: 3.1 ± 1.4). Stroke or systemic embolism was reported in 103 patients (annualized event rate: 0.82%/year), and major bleeding events were reported in 132 patients (1.05%/year). Rates of intracranial haemorrhage were low [30 patients (0.24%/year)]. Death occurred in 442 patients (3.50%/year); cardiovascular (CV) death occurred in 206 patients (1.63%/year). The approved dosing of edoxaban was chosen in 83%. All-cause and CV mortality were higher in patients receiving edoxaban 30 mg vs. 60 mg, in line with the higher age and more frequent comorbidities of the 30 mg group. Major bleeding was also numerically more common in patients receiving edoxaban 30 mg vs. 60 mg. Conclusion The rates of stroke, systemic embolism, and major bleeding are low in this large unselected cohort of high-risk AF patients routinely treated with edoxaban.
Collapse
Affiliation(s)
- Joris R de Groot
- Department of Cardiology, Amsterdam University Medical Centres/University of Amsterdam, Spui 21 1012 WX Amsterdam, The Netherlands
| | - Thomas W Weiss
- Institute for Cardiometabolic Diseases, Karl Landsteiner Society, St. Pölten, Austria
| | - Peter Kelly
- Department of Neurology, HRB Stroke Clinical Trials Network Ireland, University College Dublin/Mater Misericordiae University Hospital, Eccles St, Northside, Dublin, Ireland
| | - Pedro Monteiro
- Department of Cardiology, Centro Hospitalar e Universitário de Coimbra, Praceta Mota Pinto 3000-075, Coimbra, Portugal
| | - Jean Claude Deharo
- AP-HM, Aix Marseille University, Hôpital Timone, Cardiologie, Rythmologie, 264 rue Saint-Pierre, 13005, Marseille, France
| | - Carlo de Asmundis
- Department of Cardiology, Universitair Ziekenhuis Brussels, Ninoofsesteenweg 134, 1700 Dilbeek, Belgium
| | - Esteban López-de-Sá
- Cardiological Intensive Care Unit, Cardiology Service, Hospital Universitario La Paz, IDIPAZ, CIBER-CV, Madrid, Spain
| | - Johannes Waltenberger
- Department of Cardiovascular Medicine, University of Munster, Schlossplatz 2, 48149 Münster, Germany.,Department of Internal Medicine I, SRH Central Hospital Suhl, Albert-Schweitzer-Straße 2, 98527 Suhl, Germany
| | - Jan Steffel
- Department of Cardiology, University Hospital of Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Pierre Levy
- Department of Economics, Université Paris-Dauphine, PSL Research University, LEDa-LEGOS, Paris, France
| | - Ameet Bakhai
- Department of Cardiology, Royal Free London NHS Foundation Trust, Pond Street, London NW3 2QG, UK
| | - Wolfgang Zierhut
- Daiichi Sankyo Europe GmbH, Zielstattstr. 48, 81379 Munich, Germany
| | - Petra Laeis
- Daiichi Sankyo Europe GmbH, Zielstattstr. 48, 81379 Munich, Germany
| | | | | | - Raffaele De Caterina
- Chair of Cardiology, University of Pisa, Lungarno Antonio Pacinotti, 43, 56126 Pisa, Italy
| | - Paulus Kirchhof
- Institute of Cardiovascular Sciences, University of Birmingham, SWBH and UHB NHS Trusts, IBR 136, Wolfson Drive, Birmingham B15 2TT, UK.,Department of Cardiology, University Heart and Vascular Centre Hamburg, Villa Garbrecht, Martinistraße 52, 20251 Hamburg, Germany.,The Atrial Fibrillation NETwork (AFNET), Münster, Germany
| |
Collapse
|
22
|
Barón-Esquivias G, Roldán Rabadán I, García Quintana A, Cerezo Manchado JJ, Antorrena Miranda I, Gómez-Barrado JJ, Pérez Paredes M, Santas E, Pindado Rodríguez J, Muñoz-Robles JA, Oliver-Miñarro D, Santamaría A. Use of edoxaban in clinical practice: Comparison of data from the Spanish population in the ETNA-AF-Europe registry. Future Cardiol 2020; 16:469-480. [PMID: 32228182 DOI: 10.2217/fca-2020-0024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Aim: To ascertain the clinical profile and management of edoxaban in clinical practice. Materials & methods: Prospective, noninterventional postauthorization study of nonselected patients with atrial fibrillation treated with edoxaban from 12 European countries. Patients' baseline characteristics are presented. Results: A total of 13,638 patients (73.6 ± 9.5 years; 76.6/23.4% edoxaban 60/30 mg; CHA2DS2-VASc 3.1; 838 [6.1%] from Spain) were included. In Spain, the percentage of very elderly and fragile patients was greater and the risk of thromboembolism (CHA2DS2-VASc ≥2, 98.0 vs 87.3%; p < 0.001) and bleeding (HAS-BLED, 3.2 vs 2.7; p < 0.001) was greater in patients treated with edoxaban 30 mg. The proportion of patients taking edoxaban 30 mg was similar than in ENGAGE AF-TIMI 48. Conclusion: In Spain, patients treated with edoxaban were older and fragile.
Collapse
Affiliation(s)
| | | | - Antonio García Quintana
- Cardiology Service, Hospital Universitario de Gran Canaria Dr Negrín, Las Palmas de Gran Canaria, Spain
| | | | | | | | - Matías Pérez Paredes
- Cardiology Service, Hospital General Universitario Morales Meseguer, Murcia, Spain
| | - Enrique Santas
- Cardiology Service, Hospital Clínico Universitario, Valencia, Spain
| | | | | | | | - Amparo Santamaría
- Hematology service, Hospital Universitario del Vinalopó, Torrevieja, Spain
| | | |
Collapse
|
23
|
Ehrlinder H, Orsini N, Modig K, Hofman-Bang C, Wallén H, Gigante B. Clinical characteristics and antithrombotic prescription in elderly hospitalized atrial fibrillation patients: A cross-sectional analysis of a Swedish single-center clinical cohort. IJC HEART & VASCULATURE 2020; 27:100505. [PMID: 32258363 PMCID: PMC7114891 DOI: 10.1016/j.ijcha.2020.100505] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 02/27/2020] [Accepted: 03/18/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND Antithrombotic treatment represents a dilemma in elderly patients with atrial fibrillation since both risk of thromboembolism and bleeding are age-dependent complications. A paradigm shift occurred over the past 10 years when aspirin was overcome by warfarin and further by the direct oral anticoagulants. Here we present a clinical practice-based analysis of a cohort of elderly inpatient atrial fibrillation patients and investigate the influence of clinical factors in the choice of antithrombotic strategy. METHODS Study participants (n = 2943) are consecutive patients aged 75-104 years discharged from a Swedish university hospital with atrial fibrillation or atrial flutter as main diagnosis between November 1st 2010 and December 31st 2017. Cardiovascular risk factors, comorbidities and antithrombotic treatment at discharge were manually extracted from medical charts. A logistic regression analysis was performed to estimate predictors of the probability to receive direct oral anticoagulants (DOACs) compared to warfarin. RESULTS Patients aged ≥90 y (n = 446, women 73%) showed the highest prevalence of cardiovascular comorbidities and the highest bleeding and thromboembolic risk. DOACs became more commonly prescribed than warfarin in 2016/2017 across all ages. However, the probability to receive DOAC as compared to warfarin was lower in the presence of high bleeding risk (OR 0,55; 95% CI 0,40-0,77; p = 0,00) and high thromboembolic risk (OR 0,74; 95% CI 0,59-0,94; p = 0,01). CONCLUSION Elderly atrial fibrillation patients represent a heterogenous group where the oldest (≥90 years) show both a very high thromboembolic and bleeding risk profile. In the presence of high thromboembolic and bleeding risk, warfarin was still preferred over DOAC.
Collapse
Affiliation(s)
- Hanne Ehrlinder
- Department of Clinical Sciences, Division of Cardiovascular Medicine, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Nicola Orsini
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Karin Modig
- Unit of Epidemiology. Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Claes Hofman-Bang
- Department of Clinical Sciences, Division of Cardiovascular Medicine, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Håkan Wallén
- Department of Clinical Sciences, Division of Cardiovascular Medicine, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Bruna Gigante
- Department of Clinical Sciences, Division of Cardiovascular Medicine, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
- Cardiovascular Medicine Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
24
|
Nielsen PB, Larsen TB, Skjøth F, Søgaard M, Lip GYH. Effectiveness and safety of edoxaban in patients with atrial fibrillation: data from the Danish Nationwide Cohort. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2019; 7:31-39. [PMID: 31774504 DOI: 10.1093/ehjcvp/pvz070] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 10/30/2019] [Accepted: 11/25/2019] [Indexed: 11/12/2022]
Abstract
AIMS Edoxaban treatment for stroke prevention in atrial fibrillation (AF) has mainly been investigated in randomized controlled trials, and data reflecting clinical practice are limited. We ascertained the clinical effectiveness and safety of edoxaban 30 and 60 mg once daily among Danish patients with AF. METHODS AND RESULTS This was an observational study based on Danish nationwide registries collecting information for administrative purposes. From June 2016 through November 2018, we identified 3405 patients initiating edoxaban. After exclusions, 2285 AF patients were followed for the effectiveness outcome of thromboembolism (ischaemic stroke and/or systemic embolism) and bleeding outcomes (composite of major bleeding, gastrointestinal bleeding, and intracranial haemorrhage), as well as bleeding requiring hospitalization. Population mean age was 75 years and 43% were female; 643 patients received the 30 mg edoxaban dosage regimen and 1642 initiated 60 mg edoxaban. During follow-up, we observed 41 thromboembolic events and 89 bleeding events of which 40 events required hospitalization. Among patients with 30 mg edoxaban, the rate (per 100 person-years) of thromboembolism was 2.07 vs. 1.62 for 60 mg edoxaban. Rates of bleeding were similar for the two dosages at ∼3.85. Bleeding requiring hospitalization occurred at a rate of 1.74 for 30 mg edoxaban and 1.69 with 60 mg edoxaban. CONCLUSION In this nationwide cohort of Caucasian AF patients treated with edoxaban for stroke prevention, the clinical effectiveness and safety were in line with data from the ENGAGE AF-TIMI 48 trial. Studies investigating comparative effectiveness and safety for edoxaban in comparison with other choices of antithrombotic treatment options are needed.
Collapse
Affiliation(s)
- Peter Brønnum Nielsen
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Sdr. Skovvej 15, Aalborg DK-9000, Denmark.,Department of Cardiology, Aalborg University Hospital, Sdr. Skovvej 15, Aalborg DK-9000, Denmark
| | - Torben Bjerregaard Larsen
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Sdr. Skovvej 15, Aalborg DK-9000, Denmark.,Department of Cardiology, Aalborg University Hospital, Sdr. Skovvej 15, Aalborg DK-9000, Denmark
| | - Flemming Skjøth
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Sdr. Skovvej 15, Aalborg DK-9000, Denmark.,Unit for Clinical Biostatistics, Aalborg University Hospital, Sdr. Skovvej 15, Aalborg DK-9000, Denmark
| | - Mette Søgaard
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Sdr. Skovvej 15, Aalborg DK-9000, Denmark.,Department of Cardiology, Aalborg University Hospital, Sdr. Skovvej 15, Aalborg DK-9000, Denmark
| | - Gregory Y H Lip
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Sdr. Skovvej 15, Aalborg DK-9000, Denmark.,Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Thomas Dr, Liverpool L14 3PE, UK
| |
Collapse
|
25
|
Reply. J Am Coll Cardiol 2019; 74:2436-2437. [DOI: 10.1016/j.jacc.2019.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 09/10/2019] [Indexed: 11/18/2022]
|