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Renal Function and AF Outcomes With Edoxaban
Study Questions:
What is the impact of renal function on outcomes for patients with atrial fibrillation (AF) treated with edoxaban?
Methods:
The authors used the Korean National Health Insurance Service data between January and December 2016 to identify patients with AF who were treated with edoxaban, a factor Xa inhibitor. They explored stroke prevention effectiveness as well as safety related to bleeding for patients based on their edoxaban dose and a propensity score matched warfarin group. Outcomes were assessed in relation to renal function, estimated by the creatinine clearance.
Results:
Among 9,537 patients with AF treated with edoxaban, the median follow-up was 5.0 months. The mean age was older in patients treated with low-dose edoxaban (73 years) as compared to high-dose edoxaban (68 years). As compared to warfarin, both edoxaban doses decreased the risk of ischemic stroke or systemic embolism (adjusted hazard ratio [aHR], 0.44; 95% confidence interval [CI], 0.31-0.64 for high-dose edoxaban and aHR, 0.57; 95% CI, 0.42-0.78 for low-dose edoxaban). The risk of major bleeding was also lower (aHR, 0.40; 95% CI, 0.26-0.61 for high-dose edoxaban and aHR, 0.61; 95% CI, 0.43-0.85 for low-dose edoxaban). Overall mortality risk was also lower in the edoxaban groups as compared to the matched warfarin groups (aHR, 0.34; 95% CI, 0.22-0.52 for high-dose edoxaban and aHR, 0.55; 95% CI, 0.41-0.73 for low-dose edoxaban). In patients with creatinine clearance >95 ml/min, the incidence of stroke or systemic embolism was higher with low-dose edoxaban as compared to warfarin, but similar between the high-dose edoxaban and matched warfarin groups.
Conclusions:
The authors concluded that both doses of edoxaban were associated with lower risks of stroke and systemic embolism, major bleeding, and mortality as compared to matched warfarin patients. They also concluded that low-dose edoxaban has less effectiveness than warfarin in patients with creatinine clearance >95 ml/min.
Perspective:
Although less commonly used than apixaban or rivaroxaban, edoxaban is another factor Xa inhibitor approved for stroke prevention in AF. The package label has a black box warning that it should not be used for patients with very good renal function (creatinine clearance >95 ml/min). In this nationwide study from Taiwan, overall effectiveness and safety of edoxaban was confirmed as compared to warfarin. However, effectiveness was diminished for patients treated with low-dose edoxaban, but who have very good renal function. However, clinicians should have caution in the interpretation of these results, especially given the short follow-up time (median 5.0 months). Nonetheless, edoxaban remains a good treatment option for many patients with AF, especially if they have creatinine clearance <95 ml/min.
Clinical Topics: Anticoagulation Management, Arrhythmias and Clinical EP, Geriatric Cardiology, Prevention, Anticoagulation Management and Atrial Fibrillation, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias
Keywords: Anticoagulants, Arrhythmias, Cardiac, Atrial Fibrillation, Brain Ischemia, Creatinine, Embolism, Factor Xa Inhibitors, Geriatrics, Hemorrhage, Outcome Assessment, Health Care, Primary Prevention, Renal Insufficiency, Risk, Stroke, Vascular Diseases, Warfarin
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