Tag Archives: edoxaban

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 effect

Introduction Atrial fibrillation (AF) is encountered with increasing frequency in clinical practice,1 and is associated strongly with adverse clinical outcomes, including stroke, cardiovascular events and death.2,3 Concomitant atherosclerotic disease may increase the risk of adverse outcomes in people with AF. For example, peripheral arterial disease was present in 11% of a large cohort of European patients with AF, and increased the risk of all-cause and cardiovascular death, compared with patients with AF but no peripheral arterial disease.4 In addition, AF is associated with adverse outcomes in a range of other subgroups of patients, inclu

Introduction Atrial fibrillation (AF) more than doubles the five-year risk of stroke in middle-aged men and women.1 Prior cerebrovascular disease markedly amplifies the risk of recurrent stroke in patients with or without AF.1,2 Figure 1 shows the influence of AF and prior cerebrovascular disease (stroke or transient ischaemic attack [TIA]) on the estimated five-year risk of a composite of stroke, systemic thromboembolism, or TIA (most events were ischaemic strokes) for a 60-year-old individual, from a large cohort study conducted in the UK.1 These observations demonstrate the need for long-term treatment to reduce the risk of stroke in thes

Introduction Venous thromboembolism (VTE) is a common source of morbidity and mortality: for example, the annual incidence of deep vein thrombosis (DVT) and pulmonary embolism (PE) in the UK have been estimated as 1/10,000 and 3–4/10,000 individuals, respectively, although the latter figure is considered to be an underestimate.1,2 The majority of cases of VTE occur during or following hospitalisation, and VTE has been described as the primary source of avoidable mortality in hospital;3 accordingly, more than 95% of such patients received a VTE risk assessment in 2016.4 Vitamin K antagonists (VKA), the standard of care for managing VTE for

Introduction Three important lines of evidence have informed the debate on optimal anticoagulation for people at risk of stroke: Meta-analyses have generally supported the findings from the ENGAGE-AF TIMI-481 and Hokusai-VTE2 trials, in terms of comparable efficacy and reduced bleeding risk with non-vitamin K antagonist oral anticoagulants (NOACs) versus warfarin in patients at risk of stroke, or with acute venous thromboembolism (VTE), respectively.3-8 The randomised Birmingham Atrial Fibrillation Treatment of the Aged Study (BAFTA) trial confirmed the superiority of anticoagulation versus aspirin in elderly patients with atrial fibrillati

A new gene therapy that targets the heart and requires only one treatment session, has been found safe for patients with coronary artery disease, according to a successful trial carried out in Finland (doi: 10.1093/eurheartj/ehx352). The treatment enhances circulation in ischaemic heart muscle and the effects were still visible one year after treatment. The randomised, blinded, placebo-controlled phase 1/2a trial was carried out in collaboration between the University of Eastern Finland, Kuopio University Hospital and Turku PET Centre. The biological bypass is based on gene transfer in which a natural human growth factor, AdVEGF-DΔNΔC, a ne

Drug therapies include anticoagulants to reduce the risk of stroke and anti-arrhythmics to restore/maintain the normal heart rhythm or slow the heart rate in patients who remain in AF. Non-pharmacological management options include electrical cardioversion, which may be used to ‘shock’ the heart back to its normal rhythm. The high risk of stroke associated with electrical cardioversion can be reduced by oral anticoagulation. Although effective in reducing the risk of thromboembolism, the limitations of warfarin present considerable challenges for its use in clinical practice. The challenges of maintaining warfarin within an appropriate th

Understanding the mechanisms of AF lies at the heart of its treatment. AF occurs when structural and/or electrophysiological abnormalities alter atrial tissue to promote abnormal impulse formation and/or propagation (figure 1).3 Multiple clinical risk factors, electrocardiographic/echocardiographic features and biochemical markers are associated with an increased risk of AF (table 1), and, AF can be described in terms of the duration of episodes using a simplified scheme (table 2).3 Figure 1. Mechanisms of atrial fibrillation Table 1. Risk factors3 The aim of treatment is to prevent stroke and alleviate symptoms.4 Drug therapies include antic

Cholesterol lowering significantly reduces stroke in the elderly Use of cholesterol lowering drugs (statins and fibrates) is associated with a one third lower risk of stroke in older adults without previous disease, finds a study published in the BMJ. A research team based in France set out to determine the association between use of lipid-lowering drugs in healthy older people and long-term risk of coronary heart disease and stroke. They tracked 7,484 men and women (average age 74 years) with no known history of vascular events, such as heart attacks and strokes, living in three French cities (Bordeaux, Dijon and Montpellier). After an aver

New NICE guidance Dr Andrew Cox (St George’s, University of London) Stroke prevention is the major focus of the new National Institute of Health and Care Excellence (NICE) guidelines on atrial fibrillation (AF), which were discussed by Dr Campbell Cowan (Chair, NICE Guidelines Development Group) in one ‘Hot topics’ session at the meeting. This presentation was in anticipation of the release of the final version of the guidelines a fortnight following the conference. This limited discussion covered the already published draft guidance, but points from this draft which were discussed have since been confirmed in the published guidance