Adequately treating high-risk patients with atrial fibrillation with anticoagulants in clinical practice is often a fine line. An increased risk of bleeding, as well as the increased prevalence of renal insufficiency, pose challenges for physicians.
Atrial fibrillation is the most common sustained cardiac arrhythmia, occurring in 1-2% of the population and increasing up to 15% with age. However, especially in elderly and very old patients with atrial fibrillation, concerns about increased bleeding complications often discourage physicians from using oral anticoagulants for stroke prophylaxis. Even more, they are considered among the greatest risk factors for adverse drug-associated events. Yet one in four ischemic strokes in the elderly is due to cardioembolism caused by atrial fibrillation. Effective therapy is therefore indicated.
Treatment option NOAK
One option is in the form of non-VKA oral anticoagulants (NOAKs). For example, edoxaban (Lixiana®) is a reversible factor Xa inhibitor approved for the prophylaxis of stroke and systemic embolism in adult patients with non-valvular atrial fibrillation when one or more risk factors are present. In one study, 21,105 patients with nonvalvular AF and a CHADS2 score of at least two were treated with either warfarin or edoxaban (1× 30/15 mg/d or 1× 60/30 mg/d).
Reduce cardiac mortality
Edoxaban 60/30 mg was shown to be associated with significantly lower rates of hemorrhagic stroke and intracranial hemorrhage compared with warfarin and to have a significant reduction in cardiovascular mortality compared with warfarin. Furthermore, due to its low inhibitory effect on CYP3A4, it shows a low potential for drug-drug interactions. Therefore, it can also be used in patients with atrial fibrillation who develop malignant tumors as an alternative in the prevention of stroke with a good safety profile.
Source: Cardiology Update 2019
CARDIOVASC 2019; 18(2): 29
