Introduction

Br J Cardiol 2019;26(suppl 2):S3doi:10.5837/bjc.2019.s07 Leave a comment
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Sponsorship Statement:

The development of this supplement was commissioned and funded by Daiichi Sankyo UK Ltd, which also checked the manuscript for compliance with the ABPI Code of Practice. Editorial control of content was with The British Journal of Cardiology.

Prescribing information for Lixiana® (edoxaban) and adverse event reporting details can be found here.

Date of preparation: July 2019
Job bag number: EDX/19/0433

Atrial fibrillation (AF) is the most common cardiac arrhythmia encountered in clinical practice, and its prevalence is increasing in both genders and across age groups.1 AF promotes increased risk of adverse clinical outcomes, including death, stroke, cardiovascular events and heart failure.2,3 Venous thromboembolism (VTE) is another common condition that predisposes to premature mortality, stroke and other adverse outcomes.4,5

Effective anticoagulation improves outcomes in patients with AF or VTE.4-7 Non-vitamin K antagonist oral anticoagulants (NOACs) have provided an alternative to warfarin for prevention of stroke or recurrent VTE in these patients in recent years. Compared with warfarin, NOACs have more predictable pharmacokinetics and pharmacodynamics, do not require monitoring of the international normalised ratio (INR), and have a wider therapeutic window that enables prescription at fixed daily doses over an extended period.8

Edoxaban, an inhibitor of Factor Xa is a member of the NOAC class. The accompanying articles summarise latest findings on the effects of edoxaban on important clinical efficacy and safety outcomes from three major randomised, clinical trials:

  • Effective Anticoagulation with Factor Xa Next Generation in Atrial Fibrillation – Thrombolysis In Myocardial Infarction 48 (ENGAGE AF-TIMI-48; NCT00781391)9
  • Edoxaban versus Warfarin in Subjects Undergoing Cardioversion of Atrial Fibrillation (ENSURE-AF; NCT02072434)10
  • The edoxaban HOKUSAI-VTE Study (NCT00986154)11

We focus strongly on the efficacy and safety outcomes of edoxaban, compared with warfarin, in a broad range of patient demographic and disease subgroups within these key trials. We hope you find these articles interesting and useful in your clinical practice.

Conflicts of interest

KK has received honoraria from Bayer, Menarini and Pfizer.

Guest editor
Khalid Khan

Consultant Cardiologist

Glan Clwyd Hospital, Betsi Cadwaladr University Health Board, Sarn Lane, Rhyl, LL18 5UJ

Email: khalid.khan@wales.nhs.uk

Articles in this supplement

1. Edoxaban in patients with atrial fibrillation and co-existing cardiovascular disease
2. Edoxaban in stroke prevention in patients with a prior history of stroke or transient ischaemic attack
3. Edoxaban in the treatment and prophylaxis of venous thromboembolism
4. Role of edoxaban in the primary-care setting: opportunities and challenges

References

1. Adderley NJ, Ryan R, Nirantharakumar K, Marshall T. Prevalence and treatment of atrial fibrillation in UK general practice from 2000 to 2016. Heart 2019;105:27–33. https://doi.org/10.1136/heartjnl-2018-312977

2. European Heart Network. Atrial fibrillation and cardiovascular diseases – a European Heart Network paper. September 2015. Available at: http://www.ehnheart.org/component/attachments/attachments.html?task=download&folder=publications&id=2205 [accessed February 2019].

3. Stewart S, Hart CL, Hole DJ, McMurray JJ. A population-based study of the long-term risks associated with atrial fibrillation: 20-year follow-up of the Renfrew/Paisley study. Am J Med 2002;113:359–64. https://doi.org/10.1016/S0002-9343(02)01236-6

4. National Institute for Health and Care Excellence. Clinical Knowledge Summary. Pulmonary embolism. London: NICE, January 2019. Available from: https://cks.nice.org.uk/pulmonary-embolism

5. National Institute for Health and Care Excellence. Clinical Knowledge Summary. Deep vein thrombosis. London: NICE, September 2018. Available from: https://cks.nice.org.uk/deep-vein-thrombosis

6. Kirchhof P, Benussi S, Kotecha D et al. 2016 European Society of Cardiology guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J 2016;37:2893–962. https://doi.org/10.1093/eurheartj/ehw210

7. National Institute for Health and Care Excellence. Clinical Knowledge Summary. Atrial fibrillation. London: NICE, February 2018. Available from: https://cks.nice.org.uk/atrial-fibrillation

8. Aronis KN, Hylek EM. Evidence gaps in the era of non-vitamin K oral anticoagulants. JAMA 2018;7:e007338. https://doi.org/10.1161/JAHA.117.007338

9. Giugliano RP, Ruff CT, Braunwald E et al. Edoxaban versus warfarin in patients with atrial fibrillation. N Engl J Med 2013;369:2093–104. https://doi.org/10.1056/NEJMoa1310907

10. Lip GY, Merino J, Ezekowitz M et al. A prospective evaluation of edoxaban compared to warfarin in subjects undergoing cardioversion of atrial fibrillation: the EdoxabaN vs. warfarin in subjectS UndeRgoing cardiovErsion of Atrial Fibrillation (ENSURE-AF) study. Am Heart J 2015;169:597–604.e5. https://doi.org/10.1016/j.ahj.2015.02.009

11. The Hokusai-VTE Investigators. Edoxaban versus warfarin for the treatment of symptomatic venous thromboembolism. N Engl J Med 2013;369:1406–15. https://doi.org/10.1056/NEJMoa1306638

Disclaimer: Medinews Cardiology Limited advises healthcare professionals to consult up-to-date Prescribing Information and the full Summary of Product Characteristics available from the manufacturers before prescribing any product. Medinews Cardiology Limited cannot accept responsibility for any errors in prescribing which may occur.
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