Insights in patients with atrial fibrillation and co-existing cardiovascular disease.
No Thumbnail Available
Authors
Thomas, Honey
Issue Date
2019
Type
Article
Language
en
Keywords
atrial fibrillation , non-vitamin K antagonist oral anticoagulants (NOACs) , direct oral anticoagulants (DOACs) , warfarin , enoxaparin , edoxaban , cardiovascular disease
Alternative Title
Abstract
Patients with atrial fibrillation (AF) are at high risk of premature mortality and a range of other adverse cardiovascular and thromboembolic outcomes. The availability of newer oral anticoagulants has broadened therapeutic options beyond vitamin K antagonists, and these are supported increasingly by well-designed, randomised-controlled, outcomes trials. Here, we discuss the results, and implications for practice, of the ENGAGE-AF TIMI-48 and ENSURE-AF trials, that evaluated the Factor Xa inhibitor, edoxaban, in patients with AF. ENGAGE-AF showed that edoxaban 60 mg (reduced to 30 mg in appropriate patients) once daily was as effective as warfarin (dosed to increase INR to 2.0–3.0) in terms of the risk of stroke and systemic embolus, the study primary end point. It also induced less major bleeding and intracranial bleeding than warfarin. Subgroup analyses have given confidence that the therapeutic benefit of edoxaban is present irrespective of age, ethnicity, body mass index, common cardiovascular and other comorbidities, such as prior stroke or transient ischaemic attack, coronary artery disease, heart failure (including treatment with digoxin or amiodarone), renal dysfunction, cancer, and increased risk of falling. ENSURE-AF demonstrated that edoxaban is an appropriate alternative to warfarin/enoxaparin for patients with AF undergoing cardioversion, including immediate cardioversion guided by transoesophageal echocardiography.
Description
Citation
Khan, K. and Thomas, H. (2019) Insights in patients with atrial fibrillation and co-existing cardiovascular disease. British Journal of Cardiology; 26 (supp 2) : S4-S9.
Publisher
License
Journal
British Journal of Cardiology
Volume
Issue
PubMed ID
ISSN
1753-4313