Warfarin Versus Thrombin Inhibitor ( Dabigatran ) The RE-LY trial ( 9 , 18 ) showed that treatment with dabigatran , 150 mg , is superior to warfarin in reducing the incidence of the composite outcome of stroke or systemic embolism .
No statistically significant difference was observed between the 2 therapies with regard to major bleeding , myocardial infa rct ion , or
Atrial fibrillation ( AF ) is characterized by uncoordinated atrial activation with consequent deterioration of mechanical function ( 1 ) .
It is the most common sustained cardiac arrhythmia , and according to estimates , 12.1 million Americans will have AF by 2050 ( 2 ) .
Patients with AF have increased risk for embolic stroke , heart failure , and cognitive impairment ; reduced quality of life ; and higher overall mortality ( 35 ) .
Strokes related to AF have been characterized as more severe ( 6 , 7 ) and translate to a substantial economic burden , costing Medicare approximately $ 8 billion annually ( 8) .
Antithrombotic therapies are the mainstays for preventing thromboembolic events in patients with AF .
Oral anticoagulation with vitamin K antagonists ( VKAs ) has long been the gold st and ard therapy for stroke prevention in these patients .
However , the challenges of monitoring VKA therapy and the many associated food and drug interactions have fueled the development of novel therapeutic options .
Currently , 4 direct-acting oral anticoagulants ( DOACs ) are approved for stroke prevention in patients with nonvalvular AF : the thrombin inhibitor dabigatran and the factor Xa inhibitors apixaban , rivaroxaban , and edoxaban .
In addition , procedural interventions , such as left atrial appendage ( LAA ) occlusion devices , are an alternative treatment for patients who are at high risk for bleeding while receiving anticoagulation therapy .
This systematic review up date s previous review s ( 13 ) and aims to compare the effectiveness of the available medical and procedural therapies in preventing thromboembolic events and bleeding complications in patients with AF .
Concomitant Use of Single Antiplatelet Therapy With Edoxaban or Warfarin in Patients With Atrial Fibrillation: Analysis From the ENGAGE AF‐TIMI48 Trial
Background We studied the concomitant use of single antiplatelet therapy ( SAPT ) on the efficacy and safety of the anti‐Xa agent edoxaban in patients with atrial fibrillation ( AF ) . Methods and Results ENGAGE AF‐TIMI 48 was a r and omized trial that compared 2 dose regimens of edoxaban with warfarin . We studied both the approved high‐dose edoxaban regimen ( HDER ; 60 mg daily reduced by one half in patients with anticipated increased drug exposure ) , as well as a lower‐dose edoxaban regimen ( LDER ; 30 mg daily , also reduced by one half in patients with anticipated increased drug regimen ) . SAPT ( aspirin in 92.5 % ) was administered at the discretion of the treating physician . Cox proportional hazard regressions stratified by SAPT at 3 months with treatment as a covariate were performed . The 4912 patients who received SAPT were more frequently male , with histories of coronary artery disease and diabetes , and had higher CHADS 2Vasc and HAS BLED scores than did the 14 977 patients not receiving SAPT . When compared to patients not receiving SAPT , those receiving SAPT had a higher incidence of major bleeding ; ( adjusted hazard ratio [ HR adj]=1.46 ; 95 % CI , 1.27–1.67 , P<0.001 ) . SAPT did not alter the relative efficacy of edoxaban compared to warfarin  in preventing stroke or systemic embolic events ( SEEs ) : edoxaban versus warfarin without SAPT , hazard ratio ( HR adj for HDER)=0.94 ; ( 95 % CI : 0.77–1.15 ) with SAPT , HR adj=0.70 ( 95 % CI : 0.50–0.98 ) , P interaction ( P int)=0.14 . ( HR adj for LDER versus warfarin without SAPT=1.19 ( 95 % CI 0.99–1.43 ) With SAPT , 1.03 ( 95 % CI , 0.76–1.39 ) P int=0.42 . Major bleeding was lower with edoxaban than warfarin both without SAPT , HR adj for HDER=0.80 ( 95 % CI , 0.68–0.95 ) , and with SAPT , HR adj=0.82 ( 95 % CI , 0.65–1.03 ; P int=0.91 ) . For LDER without SAPT ( HR adj=0.56 [ 95 % CI 0.46–0.67 ] ) and with SAPT ( HR adj=0.51 [ 95 % CI 0.39–0.66 ] ) . Conclusions Patients with AF who were selected by their physicians to receive SAPT in addition to an anticoagulant had a similar risk of stroke/SEE and higher rates of bleeding than those not receiving SAPT . Edoxaban exhibited similar relative efficacy and reduced bleeding compared to warfarin , with or without concomitant SAPT . Clinical Trial Registration URL : http://www . clinical trials.gov/. Unique identifier : NCT00781391
Warfarin Versus Thrombin Inhibitor ( Dabigatran ) The RE-LY trial ( 9 , 18 ) showed that treatment with dabigatran , 150 mg , is superior to warfarin in reducing the incidence of the composite outcome of stroke or systemic embolism .
No statistically significant difference was observed between the 2 therapies with regard to major bleeding , myocardial infa rct ion , or
Atrial fibrillation ( AF ) is characterized by uncoordinated atrial activation with consequent deterioration of mechanical function ( 1 ) .
It is the most common sustained cardiac arrhythmia , and according to estimates , 12.1 million Americans will have AF by 2050 ( 2 ) .
Patients with AF have increased risk for embolic stroke , heart failure , and cognitive impairment ; reduced quality of life ; and higher overall mortality ( 35 ) .
Strokes related to AF have been characterized as more severe ( 6 , 7 ) and translate to a substantial economic burden , costing Medicare approximately $ 8 billion annually ( 8) .
Antithrombotic therapies are the mainstays for preventing thromboembolic events in patients with AF .
Oral anticoagulation with vitamin K antagonists ( VKAs ) has long been the gold st and ard therapy for stroke prevention in these patients .
However , the challenges of monitoring VKA therapy and the many associated food and drug interactions have fueled the development of novel therapeutic options .
Currently , 4 direct-acting oral anticoagulants ( DOACs ) are approved for stroke prevention in patients with nonvalvular AF : the thrombin inhibitor dabigatran and the factor Xa inhibitors apixaban , rivaroxaban , and edoxaban .
In addition , procedural interventions , such as left atrial appendage ( LAA ) occlusion devices , are an alternative treatment for patients who are at high risk for bleeding while receiving anticoagulation therapy .
This systematic review up date s previous review s ( 13 ) and aims to compare the effectiveness of the available medical and procedural therapies in preventing thromboembolic events and bleeding complications in patients with AF .