Systemic, noncerebral, arterial embolism in 21,105 patients with atrial fibrillation randomized to edoxaban or warfarin: Results from the Effective Anticoagulation With Factor Xa Next Generation in Atrial Fibrillation-Thrombolysis in Myocardial Infarction Study 48 trial

Geller, Bram J.; Giugliano, Robert P.; Braunwald, Eugene; Murphy, Sabina A.; Hanyok, James; Jin, Jianqing; Mercuri, Michele; Antman, Elliott M.; Ruff, Christian T.

doi:10.1016/j.ahj.2015.06.020

Cited by 23 publications

(27 citation statements)

References 26 publications

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“…Subsequently, 11482 records were removed for not meeting the inclusion criteria and 208 records were assessed based on full-text screening. Finally, nine studies were included in our NMA identifying four phase III RCTs (RE-LY [6,22,23], ROCKET-AF [7], ARISTOTLE [8,24], and ENGAGE AF-TIMI 48 [9,25,26]), which enrolled 71681 patients, and all the trials of low bias ( PSRF for each analysis and each result of PSRF was close to 1. According to the plots and PSRF, the model fitted better.…”

Section: Resultsmentioning

confidence: 99%

Efficacy and Safety of Non-Vitamin K Anticoagulants for Atrial Fibrillation in Relation to Different Renal Function Levels: A Network Meta-Analysis

Jin

Zhu

Wang

et al. 2020

Cardiovascular Therapeutics

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Background. We performed a network meta-analysis (NMA) comparing the efficacy (stroke or systemic embolism) and safety (major bleeding) among different non-vitamin K antagonist oral anticoagulants (NOACs) in patients with atrial fibrillation (AF) and renal impairment, with the aim of recommending the proper drug and the dose based on renal function. Methods. We searched PubMed, EMBASE, Web of Science, and Cochrane Library with the items “dabigatran, edoxaban, apixaban, rivaroxaban, warfarin, and atrial fibrillation” through August 2019. NMA was analyzed with R (version 3.5.1, R Foundation for Statistical Computing) with the packages gemtc recalling JAGS (version 4.3.0) for the efficacy and safety of each drug with regard to different levels of renal function. NetMetaXL (version 1.6.1) and winBUGS (version 1.4.3) were used to obtain the cumulative ranking curve (SUCRA) of each drug. Result. In patients with normal renal function, dabigatran150 was ranked as the most effective drug (SUCRA 0.90), followed by dabigatran110 (SUCRA 0.68), apixaban (SUCRA 0.66), and rivaroxaban (SUCRA 0.59). With regard to the safety for preventing major bleeding, there was high probability that edoxaban30 (SUCRA 0.99) ranked first, compared to dabigatran110 (SUCRA 0.78) and edoxaban60 (SUCRA 0.66). For patients with mild renal impairment, with respect to the most effective drug for preventing stroke or systemic embolism, edoxaban60 ranked first (SUCRA 0.98), in comparison with dabigatran150 (SUCRA 0.74) and apixaban (SUCRA 0.64). Possibility of ranking first for the safest drug was edoxaban30 (SUCRA 0.99), followed by dabigatran110 (SUCRA 0.70) and apixaban (SUCRA 0.69). In patients with moderate renal function, dabigatran150 (SUCRA 0.95) ranked as the most effective drug in comparison with apixaban (SUCRA 0.66). Dabigatran110 (SUCRA 0.53), rivaroxaban (SUCRA 0.51), and edoxaban60 (SUCRA 0.50) had the similar probability of ranking third. When referred to the safest drug, probability of ranking first for preventing major bleeding was edoxaban30 (SUCRA 0.98), followed by apixaban (SUCRA 0.85) and edoxaban60 (SUCRA 0.64). Conclusion. In patients with AF and renal impairment and for patients with normal renal function, dabigatran 110 mg (bid) might have a better effect on the clinical results. And it does not coincide with patients taking dabigatran 110 mg with dose reduction for other factors including aged ≥75 years, renal impairment (CrCL 30–50 mL/min), gastritis, esophagitis, or gastroesophageal reflux, receiving concomitant verapamil, and so on. For patients with mild renal impairment, apixaban 5 mg (bid) would be a better choice for preventing stroke or systemic embolism and major bleeding, while apixaban 5 mg (bid) and edoxaban 60 mg (qd) were recommended for patients with moderate renal impairment. However, considering the fact of no RCTs for the head-to-head comparison, caution should be exercised over selecting each of NOACs for patients.

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Section: Resultsmentioning

confidence: 99%

Efficacy and Safety of Non-Vitamin K Anticoagulants for Atrial Fibrillation in Relation to Different Renal Function Levels: A Network Meta-Analysis

Jin

Zhu

Wang

et al. 2020

Cardiovascular Therapeutics

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“…As its clinical manifestation lacks specificity and the specific indicators or biomarkers are currently unable to specifically identify the condition, it is frequently misdiagnosed or diagnosis is commonly delayed (8). Atrial fibrillation is the most important factor in the pathogenesis of ARI (3,6). When people suffer from atrial fibrillation, the endocardium is damaged, imbalances of thrombotic and thrombolytic mechanisms occurs, leading to the formation of an embolus, which may dislodge and travel through the systemic circulation, resulting in embolism in end organs.…”

Section: Discussionmentioning

confidence: 99%

“…A retrospective study on 438 ARI patients reported that cardiac factors were accountable for ARI in 55.7% of the cases (2), while atrial fibrillation and left atrial myxoma were common cardiac factors inducing systemic thromboembolism (3,4). Other risk factors include myocardial ischemia, coagulation disorders, hypertension, obesity, peripheral vascular disease, smoking, a prior thromboembolic event and diabetes (2,5).…”

Section: Introductionmentioning

confidence: 99%

Successful treatment of acute renal infarction arising from left atrial myxoma and atrial fibrillation: A case report

Jun-li

Liu

et al. 2017

Experimental and Therapeutic Medicine

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Abstract. Acute renal infarction (ARI) is an uncommon disease and delayed diagnosis or misdiagnosis often leads to rapid deterioration of the patient. As patients with atrial fibrillation and left atrial myxomas are at risk of developing ARI due to cardiogenic thromboembolism, it is pivotal for clinicians to make a correct diagnosis and start a timely treatment. The present study reported on the case of a 68-year-old man who suffered from ARI secondary to thromboembolism associated with atrial fibrillation and left atrial myxomas. His renal function deteriorated rapidly after the onset of the attack. He was treated with anti-coagulant agents with excellent results. Classical anti-coagulation therapy remains to be the effective and safe treatment of ARI. IntroductionAcute renal infarction (ARI) is a severe condition requiring immediate treatment and is uncommon in clinical practice. It is often induced by the thrombogenesis or embolism to the renal artery trunk and branches, which leads to ischemic necrosis of renal tissues, kidney dysfunction and at times even irreversible renal parenchyma injury, leading to nephrectomy and even death in severe cases. As ARI does not have any typical clinical symptoms, it is easily misdiagnosed.The majority of ARI cases included a case series have been reported to be of cardiac origin (1). A retrospective study on 438 ARI patients reported that cardiac factors were accountable for ARI in 55.7% of the cases (2), while atrial fibrillation and left atrial myxoma were common cardiac factors inducing systemic thromboembolism (3,4). Other risk factors include myocardial ischemia, coagulation disorders, hypertension, obesity, peripheral vascular disease, smoking, a prior thromboembolic event and diabetes (2,5). Anti-coagulant and anti-thrombotic agents are classical therapeutics for ARI. A previous study reported that percutaneous renal artery fibrinolytic therapy with re-vascularization, including aspiration and rheolytic thrombectomy, achieved an excellent result (6). However, operation trauma, post-operative complications and high mortality have limited the application of open surgery. Regarding the prognosis of renal infarction, a retrospective study of 67 patients with renal infarction reported that 41% patients suffered from acute kidney disease (AKD) (7). Another study with 20 months of follow up showed that 20% of ARI patients developed AKD, 11% developed new-onset renal insufficiency and 2.1% progressed to end-stage renal disease (2). Therefore, early diagnosis and timely treatment of ARI are pivotal for maintaining renal function and to improve the prognosis of patients affected. The present study reported on a patient with coronary artery disease (CAD), atrial fibrillation and left atrial myxoma, who developed ARI. His right kidney had lost its function due to atrophy and his renal function rapidly deteriorated to an uremic level over a period of 3 days.The anti-coagulant agents low-molecular heparin and warfarin were used after timely diagnosis. His renal function eventuall...

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“…In a recent analysis from a large clinical trial in patients with AF, the rate of SEE on anticoagulation was 0.12% per year (0.08% on a direct oral anticoagulant). 3 At the same time, clinical trials of secondary prevention strategies in patients with symptomatic PAD and no AF show ALI rates of 1.3% per year (more than 10-fold higher). Even within the dataenriched clinical trials context, estimates of ALI or SEE incidence and ascertainment of the benefits of treatments are not well defined.…”

Section: Ali Incidence and Mortality Versus Clinical Recognitionmentioning

confidence: 99%

The conundrum of ALI and systemic embolic events: SEEing our way to improved vascular health

2016

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Systemic, noncerebral, arterial embolism in 21,105 patients with atrial fibrillation randomized to edoxaban or warfarin: Results from the Effective Anticoagulation With Factor Xa Next Generation in Atrial Fibrillation-Thrombolysis in Myocardial Infarction Study 48 trial

Cited by 23 publications

References 26 publications

Efficacy and Safety of Non-Vitamin K Anticoagulants for Atrial Fibrillation in Relation to Different Renal Function Levels: A Network Meta-Analysis

Efficacy and Safety of Non-Vitamin K Anticoagulants for Atrial Fibrillation in Relation to Different Renal Function Levels: A Network Meta-Analysis

Successful treatment of acute renal infarction arising from left atrial myxoma and atrial fibrillation: A case report

The conundrum of ALI and systemic embolic events: SEEing our way to improved vascular health

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