European Heart Journal — Cardiovascular Pharmacotherapy最新文献

{"title":"The burden of cholesterol accumulation through the lifespan: why pharmacological intervention should start earlier to go further?","authors":"Alberto Zambon,&nbsp;Alberto Mello E Silva,&nbsp;Michel Farnier","doi":"10.1093/ehjcvp/pvaa123","DOIUrl":"https://doi.org/10.1093/ehjcvp/pvaa123","url":null,"abstract":"<p><p>Among the cardiovascular risk factors, cholesterol-rich atherogenic lipoproteins play a central role in the pathogenesis of atherosclerosis. In middle-aged adults, the size of the total atherosclerotic plaque burden is influenced by both the concentration of circulating atherogenic lipoproteins and the total duration of exposure to these lipoproteins. This review describes the evidence supporting a causal link between lifelong elevations in atherogenic lipoproteins and future risk of atherosclerosis; evidence strengthened by recent epidemiological, genetic, and clinical data. By consequence, adolescence and early adulthood are a crucial time for determining later cardiovascular disease risk. Arguments showing that early optimal lipid control leads to improved outcomes will be presented and suggestions put forward for how those most at risk should be identified and managed.</p>","PeriodicalId":11995,"journal":{"name":"European Heart Journal — Cardiovascular Pharmacotherapy","volume":" ","pages":"435-441"},"PeriodicalIF":7.1,"publicationDate":"2021-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1093/ehjcvp/pvaa123","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38541096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The use of novel oral anticoagulants compared to vitamin K antagonists (warfarin) in patients with left ventricular thrombus after acute myocardial infarction.","authors":"Daniel A Jones, Paul Wright, Momin A Alizadeh, Sadeer Fhadil, Krishnaraj S Rathod, Oliver Guttmann, Charles Knight, Adam Timmis, Andreas Baumbach, Andrew Wragg, Anthony Mathur, Sotiris Antoniou","doi":"10.1093/ehjcvp/pvaa096","DOIUrl":"10.1093/ehjcvp/pvaa096","url":null,"abstract":"<p><strong>Aim: </strong>Current guidelines recommend the use of vitamin K antagonist (VKA) for up to 3-6 months for treatment of left ventricular (LV) thrombus post-acute myocardial infarction (AMI). However, based on evidence supporting non-inferiority of novel oral anticoagulants (NOAC) compared to VKA for other indications such as deep vein thrombosis, pulmonary embolism (PE), and thromboembolic prevention in atrial fibrillation, NOACs are being increasingly used off licence for the treatment of LV thrombus post-AMI. In this study, we investigated the safety and effect of NOACs compared to VKA on LV thrombus resolution in patients presenting with AMI.</p><p><strong>Methods and results: </strong>This was an observational study of 2328 consecutive patients undergoing coronary angiography ± percutaneous coronary intervention (PCI) for AMI between May 2015 and December 2018, at a UK cardiac centre. Patients' details were collected from the hospital electronic database. The primary endpoint was rate of LV thrombus resolution with bleeding rates a secondary outcome. Left ventricular thrombus was diagnosed in 101 (4.3%) patients. Sixty patients (59.4%) were started on VKA and 41 patients (40.6%) on NOAC therapy (rivaroxaban: 58.5%, apixaban: 36.5%, and edoxaban: 5.0%). Both groups were well matched in terms of baseline characteristics including age, previous cardiac history (previous myocardial infarction, PCI, coronary artery bypass grafting), and cardiovascular risk factors (hypertension, diabetes, hypercholesterolaemia). Over the follow-up period (median 2.2 years), overall rates of LV thrombus resolution were 86.1%. There was greater and earlier LV thrombus resolution in the NOAC group compared to patients treated with warfarin (82% vs. 64.4%, P = 0.0018, at 1 year), which persisted after adjusting for baseline variables (odds ratio 1.8, 95% confidence interval 1.2-2.9). Major bleeding events during the follow-up period were lower in the NOAC group, compared with VKA group (0% vs. 6.7%, P = 0.030) with no difference in rates of systemic thromboembolism (5% vs. 2.4%, P = 0.388).</p><p><strong>Conclusion: </strong>These data suggest improved thrombus resolution in post-acute coronary syndrome (ACS) LV thrombosis in patients treated with NOACs compared to VKAs. This improvement in thrombus resolution was accompanied with a better safety profile for NOAC patients vs. VKA-treated patients. Thus, provides data to support a randomized trial to answer this question.</p>","PeriodicalId":11995,"journal":{"name":"European Heart Journal — Cardiovascular Pharmacotherapy","volume":" ","pages":"398-404"},"PeriodicalIF":0.0,"publicationDate":"2021-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38210693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pre-treatment with dual antiplatelet therapy in non-ST-segment elevation acute coronary syndromes: landing from guidelines recommendations to real-world ground.","authors":"Leonardo De Luca","doi":"10.1093/ehjcvp/pvab045","DOIUrl":"https://doi.org/10.1093/ehjcvp/pvab045","url":null,"abstract":"","PeriodicalId":11995,"journal":{"name":"European Heart Journal — Cardiovascular Pharmacotherapy","volume":" ","pages":"442-444"},"PeriodicalIF":7.1,"publicationDate":"2021-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39232750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of dronedarone vs. flecainide in the maintenance of sinus rhythm, following electrocardioversion in adults with persistent atrial fibrillation: a systematic review and meta-analysis.","authors":"Hannah Wilson,&nbsp;Declan Patton,&nbsp;Zena Moore,&nbsp;Tom O'Connor,&nbsp;Linda Nugent","doi":"10.1093/ehjcvp/pvaa018","DOIUrl":"https://doi.org/10.1093/ehjcvp/pvaa018","url":null,"abstract":"<p><strong>Aims: </strong>To compare flecainide and dronedarone for sinus rhythm (SR) maintenance following electrocardioversion of persistent atrial fibrillation (AF), in patients with minimal or no structural heart disease.</p><p><strong>Methods and results: </strong>A systematic search of publications using EMBASE, CENTRAL, CINAHL, and MEDLINE (1989-2019), identified a total of 595 articles. No limitations were applied. Nine articles met the inclusion criteria [five randomized controlled trials (RCTs) and four cohort studies], encompassing 1349 persistent AF candidates. Two retrospective studies compared flecainide with dronedarone, indicating a 6% reduced risk of AF recurrence with flecainide; however, results were not statistically significant [risk ratio (RR) 0.94, 95% confidence interval (CI) 0.71-1.24; P = 0.66]. One RCT compared dronedarone to placebo, demonstrating a 28% reduced risk of AF recurrence at 6 months (RR 0.72, 95% CI 0.58-0.90; P = 0.004). Two RCTs compare flecainide to placebo, when a 16% decreased risk of AF recurrence at 6-12 months was indicated; however, these results were not statistically significant (RR 0.84, 95% CI 0.66-1.07; P = 0.16). Within a 6- to 12-month follow-up period, a combined recurrence rate of AF was examined, in which flecainide and dronedarone maintained SR in 50% and 42%, respectively. Four articles satisfied quality appraisal, one of which focused on flecainide data.</p><p><strong>Conclusion: </strong>Dronedarone and flecainide displayed similar efficacy in maintaining SR in patients following electrocardioversion for persistent AF. The SR maintenance was numerically but not statistically significant in the flecainide group. Side effects uncovered similar pro-arrhythmic activity. However, in light of the deficiency of volume and quality of available evidence, the writer acknowledges the requirement for future research.</p>","PeriodicalId":11995,"journal":{"name":"European Heart Journal — Cardiovascular Pharmacotherapy","volume":" ","pages":"363-372"},"PeriodicalIF":7.1,"publicationDate":"2021-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1093/ehjcvp/pvaa018","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37729881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and safety of direct oral anticoagulants vs. low molecular weight heparin for cancer-related venous thromboembolism: a meta-analysis of randomized trials.","authors":"Ayman Elbadawi,&nbsp;Mina Shnoda,&nbsp;Karim Mahmoud,&nbsp;Islam Y Elgendy","doi":"10.1093/ehjcvp/pvaa067","DOIUrl":"https://doi.org/10.1093/ehjcvp/pvaa067","url":null,"abstract":"<p><strong>Aims: </strong>To examine the efficacy and safety of direct oral anticoagulants (DOACs) vs. low molecular weight heparin (LMWH) in patients with cancer-related venous thromboembolism (VTE).</p><p><strong>Methods and results: </strong>An electronic search of the MEDLINE, SCOPUS, and Cochrane databases without language restrictions was performed through April 2020 for randomized controlled trials that compared the outcomes with DOACs vs. LMWH among patients with cancer-related VTE. Summary estimates were reported using random effects model. The main efficacy outcome was VTE recurrence, while the main safety outcome was major bleeding . The final analysis included four randomized trials with a total of 2907 patients. The weighted mean follow-up was 6.1 months. Compared with LMWH, DOACs were associated with lower incidence of VTE recurrence [5.7% vs. 9.1%, risk ratio (RR) 0.62; 95% confidence interval (CI) 0.44-0.87; P = 0.01], driven by lower incidence of deep venous thrombosis (RR 0.60, 95% CI 0.39-0.93; P = 0.02). There was no difference in the incidence of major bleeding between DOACs and LMWH (4.8% vs. 3.6%, RR 1.33; 95% CI 0.84-2.11; P = 0.23). The incidence of all-cause mortality was similar (RR 0.99; 95% CI 0.84-1.16; P = 0.91). Subgroup analysis suggested no differences according to the type of DOAC regarding recurrent VTE or major bleeding (Pinteraction = 0.53 and Pinteraction = 0.11, respectively).</p><p><strong>Conclusion: </strong>Among patients with cancer-related VTE, DOACs were associated with lower incidence of VTE recurrence and no difference in the incidence of major bleeding compared with LMWH. Future studies examining the subset of cancer patients who drive the most benefit are encouraged.</p>","PeriodicalId":11995,"journal":{"name":"European Heart Journal — Cardiovascular Pharmacotherapy","volume":" ","pages":"380-388"},"PeriodicalIF":7.1,"publicationDate":"2021-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1093/ehjcvp/pvaa067","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38059271","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"All-cause mortality, stroke, and bleeding in patients with atrial fibrillation and valvular heart disease.","authors":"Jarl Emanuel Strange,&nbsp;Caroline Sindet-Pedersen,&nbsp;Laila Staerk,&nbsp;Erik Lerkevang Grove,&nbsp;Thomas Alexander Gerds,&nbsp;Christian Torp-Pedersen,&nbsp;Gunnar H Gislason,&nbsp;Jonas Bjerring Olesen","doi":"10.1093/ehjcvp/pvaa011","DOIUrl":"https://doi.org/10.1093/ehjcvp/pvaa011","url":null,"abstract":"<p><strong>Aims: </strong>To compare the risk of all-cause mortality, stroke, and bleeding in patients with atrial fibrillation (AF) and valvular heart disease (VHD) treated with vitamin K antagonist (VKA) or factor Xa-inhibitors (FXa-I; rivaroxaban and apixaban).</p><p><strong>Methods and results: </strong>We cross-linked data from Danish nationwide registries identifying patients with AF and VHD (aortic stenosis/insufficiency, mitral insufficiency, bioprosthetic heart valves, mitral-, and aortic valve repair) initiating VKA or FXa-I between January 2014 and June 2017. Outcomes were all-cause mortality, stroke, and bleeding. Using cause-specific Cox regression, we reported the standardized absolute 2-year risk of the outcomes and absolute risk differences (ARD). We identified 1115 (41.7%), 620 (23.1%), and 942 (35.2%) patients initiating treatment with VKA, rivaroxaban, and apixaban, respectively. The standardized absolute risk (95% confidence interval) of all-cause mortality associated with VKA treatment was 34.1% (30.4-37.8%) with corresponding ARD for FXa-I of -2.7% (-6.7% to 1.4%). The standardized absolute risk of stroke for VKA was 3.8% (2.2-5.4%) with corresponding ARD for FXa-I of -0.1% (-2.0% to 1.8%). The standardized risk of bleeding for VKA was 10.4% (7.2-12.9%) with corresponding ARD for FXa-I of -2.0% (-5.1% to 1.1%). The risk of bleeding was significantly reduced in subgroup analyses of apixaban compared with VKA [ARD: -3.9% (-7.0% to -0.9%)] and rivaroxaban [ARD: -5.6% (-9.5% to -1.7%)].</p><p><strong>Conclusion: </strong>In this nationwide cohort study, there were no significant differences in the risks of all-cause mortality, stroke, and bleeding in patients with AF and VHD treated with VKA compared with FXa-I.</p>","PeriodicalId":11995,"journal":{"name":"European Heart Journal — Cardiovascular Pharmacotherapy","volume":" ","pages":"f93-f100"},"PeriodicalIF":7.1,"publicationDate":"2021-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1093/ehjcvp/pvaa011","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37649105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thromboembolism and bleeding complications in anticoagulated patients with atrial fibrillation and native aortic or mitral valvular heart disease: a descriptive nationwide cohort study.","authors":"Line Melgaard,&nbsp;Thure Filskov Overvad,&nbsp;Martin Jensen,&nbsp;Gregory Y H Lip,&nbsp;Torben Bjerregaard Larsen,&nbsp;Peter Brønnum Nielsen","doi":"10.1093/ehjcvp/pvaa008","DOIUrl":"https://doi.org/10.1093/ehjcvp/pvaa008","url":null,"abstract":"<p><strong>Aims: </strong>To describe the risks of thromboembolism and major bleeding complications in anticoagulated patients with atrial fibrillation (AF) and native aortic or mitral valvular heart disease using data reflecting clinical practice.</p><p><strong>Methods and results: </strong>Descriptive cohort study of anticoagulated patients with incident AF and native aortic or mitral valvular heart disease, identified in nationwide Danish registries from 2000 to 2018. A total of 10 043 patients were included, of which 5190 (51.7%) patients had aortic stenosis, 1788 (17.8%) patients had aortic regurgitation, 327 (3.3%) patients had mitral stenosis, and 2738 (27.3%) patients had mitral regurgitation. At 1 year after AF diagnosis, the risk of thromboembolism was 4.6% in patients with mitral stenosis taking a vitamin K antagonist (VKA), and 2.6% in patients with aortic stenosis taking a VKA or non-vitamin K antagonist oral anticoagulant (NOAC). For patients with aortic or mitral regurgitation, the risks of thromboembolism ranged between 1.5%-1.8% in both treatment groups. For the endpoint of major bleeding, the risk was ∼5.5% in patients with aortic stenosis or mitral stenosis treated with a VKA, and 3.3-4.0% in patients with aortic or mitral regurgitation. For patients treated with a NOAC, the risk of major bleeding was 3.7% in patients with aortic stenosis and ∼2.5% in patients with aortic or mitral regurgitation.</p><p><strong>Conclusion: </strong>When using data reflecting contemporary clinical practice, our observations suggested that 1 year after a diagnosis of AF, anticoagulated patients with aortic or mitral valvular heart disease had dissimilar risk of thromboembolism and major bleeding complications. Specifically, patients with aortic stenosis or mitral stenosis were high-risk subgroups. This observation may guide clinicians regarding intensity of clinical follow-up.</p>","PeriodicalId":11995,"journal":{"name":"European Heart Journal — Cardiovascular Pharmacotherapy","volume":" ","pages":"f101-f110"},"PeriodicalIF":7.1,"publicationDate":"2021-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1093/ehjcvp/pvaa008","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37597494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Motivational Interviewing to Support Oral AntiCoagulation adherence in patients with non-valvular Atrial Fibrillation (MISOAC-AF): a randomized clinical trial.","authors":"Apostolos Tzikas,&nbsp;Athanasios Samaras,&nbsp;Anastasios Kartas,&nbsp;Dimitra Vasdeki,&nbsp;George Fotos,&nbsp;George Dividis,&nbsp;Eleni Paschou,&nbsp;Evropi Forozidou,&nbsp;Paraskevi Tsoukra,&nbsp;Eleni Kotsi,&nbsp;Ioannis Goulas,&nbsp;Haralambos Karvounis,&nbsp;George Giannakoulas","doi":"10.1093/ehjcvp/pvaa039","DOIUrl":"https://doi.org/10.1093/ehjcvp/pvaa039","url":null,"abstract":"<p><strong>Aims: </strong>We aimed to assess the impact of an educational, motivational intervention on the adherence to oral anticoagulation (OAC) in patients with non-valvular atrial fibrillation (AF).</p><p><strong>Methods and results: </strong>Hospitalized patients with non-valvular AF who received OAC were randomly assigned to usual medical care or a proactive intervention, comprising motivational interviewing, and tailored counselling on medication adherence. The primary study outcome was adherence to OAC at 1 year, which was evaluated according to proportion of days covered (PDC) by OAC regimens and was assessed through nationwide registers of prescription claims. Secondary outcomes included the rate of persistence to OAC, gaps in treatment, and clinical events. A total of 1009 patients were randomized, 500 in the intervention group and 509 in the control group. At 1-year follow-up, 77.2% (386/500) of patients in the intervention group were adherent (PDC > 80%), compared with 55% (280/509) in the control group [adjusted odds ratio (aOR) 2.84, 95% confidence interval (CI) 2.14-3.75; P < 0.001]. Mean PDC ± standard deviation was 0.85 ± 0.26 and 0.75 ± 0.31, respectively (P < 0.001). Patients that received the intervention were more likely to persist in their OAC therapy at 1 year (aOR 2.42, 95% CI 1.71-3.41; P < 0.001). Usual medical care was associated with more major (≥3 months) treatment gaps (aOR 2.39, 95% CI 1.76-3.26; P < 0.001). Clinical events over a median follow-up period of 2 years did not differ among treatment groups.</p><p><strong>Conclusion: </strong>In patients receiving OAC therapy for non-valvular AF, a multilevel motivational intervention significantly improved medication adherence and rate of therapy persistence, and reduced major gaps in treatment. No significant impact on clinical outcomes was observed.</p><p><strong>Trial registration number: </strong>NCT02941978.</p>","PeriodicalId":11995,"journal":{"name":"European Heart Journal — Cardiovascular Pharmacotherapy","volume":" ","pages":"f63-f71"},"PeriodicalIF":7.1,"publicationDate":"2021-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1093/ehjcvp/pvaa039","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37876107","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Double vs. triple antithrombotic therapy in atrial fibrillation patients undergoing percutaneous coronary intervention: does clinical presentation matter?","authors":"Andrea Rubboli,&nbsp;Jean-Philippe Collet","doi":"10.1093/ehjcvp/pvaa121","DOIUrl":"https://doi.org/10.1093/ehjcvp/pvaa121","url":null,"abstract":"","PeriodicalId":11995,"journal":{"name":"European Heart Journal — Cardiovascular Pharmacotherapy","volume":" ","pages":"f61-f62"},"PeriodicalIF":7.1,"publicationDate":"2021-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1093/ehjcvp/pvaa121","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38651759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Edoxaban for stroke prevention in atrial fibrillation in routine clinical care: 1-year follow-up of the prospective observational ETNA-AF-Europe study.","authors":"Joris R de Groot,&nbsp;Thomas W Weiss,&nbsp;Peter Kelly,&nbsp;Pedro Monteiro,&nbsp;Jean Claude Deharo,&nbsp;Carlo de Asmundis,&nbsp;Esteban López-de-Sá,&nbsp;Johannes Waltenberger,&nbsp;Jan Steffel,&nbsp;Pierre Levy,&nbsp;Ameet Bakhai,&nbsp;Wolfgang Zierhut,&nbsp;Petra Laeis,&nbsp;Marius Constantin Manu,&nbsp;Paul-Egbert Reimitz,&nbsp;Raffaele De Caterina,&nbsp;Paulus Kirchhof","doi":"10.1093/ehjcvp/pvaa079","DOIUrl":"https://doi.org/10.1093/ehjcvp/pvaa079","url":null,"abstract":"<p><strong>Aims: </strong>Non-vitamin K oral anticoagulants are safe and effective for stroke prevention in patients with atrial fibrillation (AF). Data on the safety and efficacy of edoxaban in routine care are limited in Europe. We report 1-year outcomes in patients with AF treated with edoxaban in routine care.</p><p><strong>Methods and results: </strong>ETNA-AF-Europe is a prospective, multicentre, post-authorization, observational study enrolling patients treated with edoxaban in 10 European countries, the design of which was agreed with the European Medicines Agency as part of edoxaban's post-approval safety plan. Altogether 13 092 patients in 852 sites completed the 1-year follow-up [mean age: 73.6 ± 9.5 years; 57% male, mean follow-up: 352 ± 49 days (median: 366 days)]. Most patients had associated comorbidities (mean CHA2DS2-VASc score: 3.1 ± 1.4). Stroke or systemic embolism was reported in 103 patients (annualized event rate: 0.82%/year), and major bleeding events were reported in 132 patients (1.05%/year). Rates of intracranial haemorrhage were low [30 patients (0.24%/year)]. Death occurred in 442 patients (3.50%/year); cardiovascular (CV) death occurred in 206 patients (1.63%/year). The approved dosing of edoxaban was chosen in 83%. All-cause and CV mortality were higher in patients receiving edoxaban 30 mg vs. 60 mg, in line with the higher age and more frequent comorbidities of the 30 mg group. Major bleeding was also numerically more common in patients receiving edoxaban 30 mg vs. 60 mg.</p><p><strong>Conclusion: </strong>The rates of stroke, systemic embolism, and major bleeding are low in this large unselected cohort of high-risk AF patients routinely treated with edoxaban.</p>","PeriodicalId":11995,"journal":{"name":"European Heart Journal — Cardiovascular Pharmacotherapy","volume":" ","pages":"f30-f39"},"PeriodicalIF":7.1,"publicationDate":"2021-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1093/ehjcvp/pvaa079","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38269188","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}