A New Review Stresses that Non-Vitamin K Antagonist Oral Anticoagulants Can Reduce Atrial Fibrillation-Related Stroke With Significantly Reduced Cardiovascular and Bleeding Risks Compared With Warfarin
LONDON, June 9, 2016 /PRNewswire/ --
Peter Kelly, Carlos Molina, Christian T. Ruff, Roland Veltkamp. European Neurological Review, 2016;11(1):27-35. http://doi.org/10.17925/ENR.2016.11.01.1a
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A review that explores the improved patient outcomes resulting from atrial fibrillation (AF) prevention has been published recently in European Neurological Review the peer-reviewed journal from touchNEUROLOGY., Peter Kelly et al describe the rising incidence of AF that is resulting in a substantial worldwide increase in AF-related stroke, particularly in elderly patients and this is creating a serious healthcare burden. Guidelines recommend the use of AF-related stroke prophylaxis but adherence to these remains poor. Studies conducted in the 1990s showed that warfarin reduced the risk of AF-related stroke by an overall 64% compared with placebo. Subsequently, prophylactic treatment was further improved with the development of non-vitamin K antagonist oral anticoagulants (NOACs). More recently, a meta-analysis of four large clinical trials on NOACs (dabigatran, rivaroxaban, apixaban, and edoxaban) showed there was a relative risk reduction of 0.81 (p<0.0001) favouring NOAC treatment over warfarin for stroke or systemic embolic events in patients with AF. The largest trial of NOACs in AF-related stroke, to date, was the ENGAGE AF-TIMI 48 study (n=21,105) which showed that edoxaban was non-inferior to warfarin for ischaemic stroke reduction but significantly reduced bleeding and cardiovascular mortality. A recent subgroup analysis of this study showed that with edoxaban the incidences of intracranial haemorrhage (ICH) subtypes (all ICH, fatal ICH, fatal, subdural and epidural bleed) were significantly lower with 60 mg of edoxaban (p=0.013-<0.001). Edoxaban was also shown to be an effective option in patients with prior stroke. In addition, edoxaban was shown to reduce deaths due to fatal bleeds compared with warfarin. The results of current studies, especially the ENGAGE AF-TIMI 48 subgroup analysis therefore, show that the benefits of anticoagulation therapy in patients with AF substantially outweigh the risks
The full peer-reviewed, open-access article is available here:
http://doi.org/10.17925/ENR.2016.11.01.1a
Disclosure: Peter Kelly has served on advisory boards or received speakers fees or benefits from the American Stroke Association, Bayer and Daiichi Sankyo, and has received research unit grants from the Health Research Board of Ireland, Irish Heart Foundation and Bayer. Carlos Molina has nothing to declare in relation to this article. Christian T. Ruff has received research support from GlaxoSmithKline, Daiichi Sankyo, Intarcia and AstraZeneca, and serves as a consultant and on the advisory boards for Boehringer Ingelheim, Bayer, Daiichi Sankyo, Portola and DrugDev. Roland Veltkamp has received speaker fees, consulting honoraria and research support from Bayer, Boehringer Ingelheim, BMS, Pfizer, Daiichi Sankyo, CSL Behring, Apoplex Medical Technologies, Morphosys, Biogen, Medtronic.
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