April 29, 2021
The European Heart Rhythm Association (EHRA) has come out with the fourth iteration of its practical guide on the use of non-vitamin K antagonist oral anticoagulants (NOACs) in patients with atrial fibrillation (AF), which has helped physicians deploy these medications since it first came out in 2013.
Senior author Hein Heidbüchel, MD, PhD (Antwerp University Hospital, Belgium), past president of EHRA, explained that the guide is meant to supplement and not supplant clinical practice guidelines. The comprehensive document covers everything from dosing and drug-drug interactions to use in high-risk patient groups, management of bleeding, and what to do when patients undergo various procedures.
March 02, 2021
The lower dose of edoxaban (Savaysa; Daiichi-Sankyo) evaluated in ENGAGE AF-TIMI 48 provides a net clinical benefit, according to a new analysis of the trial, suggesting it may be useful for some patients with atrial fibrillation (AF).
The trial evaluated two doses of the direct oral anticoagulant (DOAC) versus warfarin 60 and 30 mg once daily; both could be cut in half in patients meeting certain criteria. The rate of a net clinical outcome incorporating stroke/systemic embolism, major bleeding, or death was significantly lower in patients who received the lower- versus higher-dose regimen (7.26% vs 8.01%; HR 0.90; 95% CI 0.84-0.98).
However, there was a trade-off with the lower dose it was associated with a greater risk of stroke/systemic embolism compared with the higher dose but with reduced risks of major, intracranial, GI, and life-threatening bleeding.