Anticoagulation in device-detected atrial fibrillation with or without vascular disease: a combined analysis of the NOAH-AFNET 6 and ARTESiA trials: a combined analysis of the NOAH-AFNET 6 and ARTESiA trials
Uložené v:
| Názov: | Anticoagulation in device-detected atrial fibrillation with or without vascular disease: a combined analysis of the NOAH-AFNET 6 and ARTESiA trials: a combined analysis of the NOAH-AFNET 6 and ARTESiA trials |
|---|---|
| Autori: | Schnabel, Renate, Mazuecos, Juan Benezet, Becher, Nina, F Mcintyre, William, Fierenz, Alexander, Lee, Shun Fu, Goette, Andreas, Atar, Dan, Bertaglia, Emanuele, P Benz, Alexander, Chlouverakis, Gregory, H Birnie, David, Dichtl, Wolfgang, Blomström-Lundqvist, Carina, Camm, A, W Erath, Julia, Simantirakis, Emmanuel, Kutyifa, Valentina, Lip, Gregory Y.H., Mabo, Philippe, Marijon, Eloi, Rivard, Léna, Schotten, Ulrich, Alings, Marco, Sehner, Susanne, Toennis, Tobias, Linde, Cecilia, Vardas, Panos, Granger, Christopher, Zapf, Antonia, Lopes, Renato, Healey, Jeff S, Kirchhof, Paulus |
| Prispievatelia: | Jonchère, Laurent |
| Zdroj: | Eur Heart J Schnabel, R B, Benezet-Mazuecos, J, Becher, N, McIntyre, W F, Fierenz, A, Lee, S F, Goette, A, Atar, D, Bertaglia, E, Benz, A P, Chlouverakis, G, Birnie, D H, Dichtl, W, Blomstrom-Lundqvist, C, Camm, A J, Erath, J W, Simantirakis, E, Kutyifa, V, Lip, G Y H, Mabo, P, Marijon, E, Rivard, L, Schotten, U, Alings, M, Sehner, S, Toennis, T, Linde, C, Vardas, P, Granger, C B, Zapf, A, Lopes, R, Healey, J S & Kirchhof, P 2024, 'Anticoagulation in device-detected atrial fibrillation with or without vascular disease: a combined analysis of the NOAH-AFNET 6 and ARTESiA trials', European Heart Journal, vol. 45, no. 46, ehae596, pp. 4902-4916. https://doi.org/10.1093/eurheartj/ehae596 |
| Informácie o vydavateľovi: | Oxford University Press (OUP), 2024. |
| Rok vydania: | 2024 |
| Predmety: | Male, Oral anticoagulation, Myocardial Infarction, Hemorrhage, Trial, Kardiologi och kardiovaskulära sjukdomar, Hemorrhage/chemically induced, Atrial Fibrillation, Myocardial Infarction/epidemiology, Humans, atrial fibrillation, Ischemic Attack, Transient/prevention & control, Stroke/prevention & control, Aged, oral anticoagulation, Atrial Fibrillation/drug therapy, Device-detected atrial fibrillation, Anticoagulants, trial, Middle Aged, stroke, Atrial fibrillation, [SDV.MHEP.CSC] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, device-detected atrial fibrillation, Stroke, Treatment Outcome, Anticoagulants/therapeutic use, Ischemic Attack, Transient, Female, Fast Track – Clinical Research, Cardiology and Cardiovascular Disease |
| Popis: | Background and Aims The optimal antithrombotic therapy in patients with device-detected atrial fibrillation (DDAF) is unknown. Concomitant vascular disease can modify the benefits and risks of anticoagulation. Methods These pre-specified analyses of the NOAH-AFNET 6 (n = 2534 patients) and ARTESiA (n = 4012 patients) trials compared anticoagulation with no anticoagulation in patients with DDAF with or without vascular disease, defined as prior stroke/transient ischaemic attack, coronary or peripheral artery disease. Efficacy outcomes were the primary outcomes of both trials, a composite of stroke, systemic arterial embolism (SE), myocardial infarction, pulmonary embolism or cardiovascular death, and stroke or SE. Safety outcomes were major bleeding or major bleeding and death. Results In patients with vascular disease (NOAH-AFNET 6, 56%; ARTESiA, 46%), stroke, myocardial infarction, systemic or pulmonary embolism, or cardiovascular death occurred at 3.9%/patient-year with and 5.0%/patient-year without anticoagulation (NOAH-AFNET 6), and 3.2%/patient-year with and 4.4%/patient-year without anticoagulation (ARTESiA). Without vascular disease, outcomes were equal with and without anticoagulation (NOAH-AFNET 6, 2.7%/patient-year; ARTESiA, 2.3%/patient-year in both randomized groups). Meta-analysis found consistent results across both trials (I2heterogeneity = 6%) with a trend for interaction with randomized therapy (pinteraction = .08). Stroke/SE behaved similarly. Anticoagulation equally increased major bleeding in vascular disease patients [edoxaban, 2.1%/patient-year; no anticoagulation, 1.3%/patient-year; apixaban, 1.7%/patient-years; no anticoagulation, 1.1%/patient-year; incidence rate ratio 1.55 (1.10–2.20)] and without vascular disease [edoxaban, 2.2%/patient-year; no anticoagulation, 0.6%/patient-year; apixaban, 1.4%/patient-year; no anticoagulation, 1.1%/patient-year; incidence rate ratio 1.93 (0.72–5.20)]. Conclusions Patients with DDAF and vascular disease are at higher risk of stroke and cardiovascular events and may derive a greater benefit from anticoagulation than patients with DDAF without vascular disease. |
| Druh dokumentu: | Article Other literature type |
| Popis súboru: | application/pdf |
| Jazyk: | English |
| ISSN: | 1522-9645 0195-668X |
| DOI: | 10.1093/eurheartj/ehae596 |
| Prístupová URL adresa: | https://pubmed.ncbi.nlm.nih.gov/39222018 http://www.scopus.com/inward/record.url?scp=85212457363&partnerID=8YFLogxK https://vbn.aau.dk/da/publications/927e7411-35ae-4f61-9e5a-06d3c012c7b8 https://doi.org/10.1093/eurheartj/ehae596 https://vbn.aau.dk/ws/files/760104818/Schnabel_et_al._2024_._Anticoagulation_in_device-detected_atrial_fibrillation_with_or_without_vascular_disease_-_a_combined_analysis_of_the_NOAH-AFNET_6_and_ARTESiA_trials.pdf https://hal.science/hal-04699752v1/document https://doi.org/10.1093/eurheartj/ehae596 https://hal.science/hal-04699752v1 http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-546207 |
| Rights: | CC BY NC URL: http://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com. |
| Prístupové číslo: | edsair.doi.dedup.....a1ebffce44f049a2c1bd922620e5aeec |
| Databáza: | OpenAIRE |
Full Text Finder 
Nájsť tento článok vo Web of Science | Abstrakt: | Background and Aims The optimal antithrombotic therapy in patients with device-detected atrial fibrillation (DDAF) is unknown. Concomitant vascular disease can modify the benefits and risks of anticoagulation. Methods These pre-specified analyses of the NOAH-AFNET 6 (n = 2534 patients) and ARTESiA (n = 4012 patients) trials compared anticoagulation with no anticoagulation in patients with DDAF with or without vascular disease, defined as prior stroke/transient ischaemic attack, coronary or peripheral artery disease. Efficacy outcomes were the primary outcomes of both trials, a composite of stroke, systemic arterial embolism (SE), myocardial infarction, pulmonary embolism or cardiovascular death, and stroke or SE. Safety outcomes were major bleeding or major bleeding and death. Results In patients with vascular disease (NOAH-AFNET 6, 56%; ARTESiA, 46%), stroke, myocardial infarction, systemic or pulmonary embolism, or cardiovascular death occurred at 3.9%/patient-year with and 5.0%/patient-year without anticoagulation (NOAH-AFNET 6), and 3.2%/patient-year with and 4.4%/patient-year without anticoagulation (ARTESiA). Without vascular disease, outcomes were equal with and without anticoagulation (NOAH-AFNET 6, 2.7%/patient-year; ARTESiA, 2.3%/patient-year in both randomized groups). Meta-analysis found consistent results across both trials (I2heterogeneity = 6%) with a trend for interaction with randomized therapy (pinteraction = .08). Stroke/SE behaved similarly. Anticoagulation equally increased major bleeding in vascular disease patients [edoxaban, 2.1%/patient-year; no anticoagulation, 1.3%/patient-year; apixaban, 1.7%/patient-years; no anticoagulation, 1.1%/patient-year; incidence rate ratio 1.55 (1.10–2.20)] and without vascular disease [edoxaban, 2.2%/patient-year; no anticoagulation, 0.6%/patient-year; apixaban, 1.4%/patient-year; no anticoagulation, 1.1%/patient-year; incidence rate ratio 1.93 (0.72–5.20)]. Conclusions Patients with DDAF and vascular disease are at higher risk of stroke and cardiovascular events and may derive a greater benefit from anticoagulation than patients with DDAF without vascular disease. |
|---|---|
| ISSN: | 15229645 0195668X |
| DOI: | 10.1093/eurheartj/ehae596 |