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 .
Efficacy and safety of edoxaban compared with warfarin in patients with atrial fibrillation and heart failure: insights from ENGAGE AF-TIMI 48.
AIMS In the ENGAGE AF-TIMI 48 trial , edoxaban , a factor Xa inhibitor , was not found to be inferior to warfarin for the prevention of stroke or systemic embolic events ( SEE ) in patients with atrial fibrillation ( AF ) and was associated with significantly less bleeding . The higher-dose edoxaban regimen ( HDER ; 60 mg dose-reduced to 30 mg once daily ) has been approved in various countries in Europe , the USA , and Japan . Among patients treated with vitamin K antagonists ( VKAs ) , symptomatic heart failure ( HF ) is an independent risk factor for lower time-in-therapeutic range , which reduces the efficacy and safety of VKA therapy . We evaluated the efficacy and safety of edoxaban compared with warfarin across the spectrum of HF severity in the ENGAGE AF-TIMI 48 trial . METHODS AND RESULTS Of 14 071 patients r and omized to well-controlled warfarin or the HDER , 5926 ( 42 % ) had no history of HF , 6344 ( 45 % ) were in New York Heart Association ( NYHA ) class I-II , and 1801 ( 13 % ) were in NYHA class III-IV . The efficacy of edoxaban compared with warfarin in preventing stroke/SEE was similar in patients without and with HF regardless of the severity of HF ; [ HDER vs. warfarin : No-HF : hazard ratio ( HR ) 0.87 , 95 % confidence interval ( CI ) 0.69 - 1.11 ; NYHA class I-II : HR 0.88 , 95 % CI 0.69 - 1.12 ; NYHA class III-IV : HR 0.83 , 95 % CI 0.55 - 1.25 ; Pinteraction = 0.97 ] . Compared with warfarin , HDER was consistently associated with lower risk of major bleeding ( No-HF : HR 0.82 , 95 % CI 0.68 - 0.99 ; NYHA class I-II : HR 0.79 , 95 % CI 0.65 - 0.96 ; NYHA class III-IV : HR 0.79 , 95 % CI 0.54 - 1.17 ; Pinteraction = 0.96 ) . CONCLUSION The relative efficacy and safety of HDER compared with well-managed warfarin in AF patients with HF were similar to those without HF
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 .