Effects of anticoagulation in patients with device-detected atrial fibrillation and multiple stroke risk factors: a win ratio analysis of the NOAH-AFNET 6 trial
Year: 2025
Type: article
Abstract: AIMS: Patients with device-detected atrial fibrillation (DDAF) have a lower stroke risk than those with ECG-diagnosed AF, requiring careful evaluation of oral anticoagulation benefits vs. its inherent bleeding risk. METHODS AND RESULTS: An unmatched win ratio analysis was performed of the NOAH-AFNET 6 trial dataset, using components of the primary efficacy and safety outcomes of the trial. The primary analysis used this hierarchical order: (1) all-cause death, (2) stroke, (3) systemic or pulmonary embolism/myocardial infarction, and (4) major bleeding. Two additional analyses replaced all-cause death with cardiovascular death or included patient-reported outcomes. Win odds were calculated to account for undecided comparisons. Among 2534 patients 77 ± 7 years old, 947 (37%) women, median CHA2DS2-VA score 3 [interquartile range (IQR), 3-4], median follow-up 21 months (IQR, 10-38) 1 605 280 win ratio pairs were analyzed. The win ratio comparing edoxaban to no anticoagulation was 0.87 (95% CI: 0.68-1.10; P = 0.23). Most comparisons resulted in no clear winner (undecided pairs 84.9%). In the remaining comparisons, edoxaban won in 46% of the cases, placebo in 54%. Death and major bleeding were the most common events. The win odds was 0.98 (95% CI: 0.94-1.01; P = 0.23). CONCLUSIONS: This hypothesis-generating win ratio analysis, integrating death, thrombotic events, and major bleeds with and without quality of life, did not find an advantage of anticoagulation with edoxaban over no anticoagulation in patients with DDAF. The most common events were death and major bleeding.
Authors: Nina Becher, Gina Köllner, Emanuele Bertaglia, Carina Blomstrom-Lundqvist, Axel Brandes, Vincent Beuger, Melanie Calvert, A John Camm, Nuno Cabanelas, Gregory Chlouverakis, Gheorghe-Andrei Dan, Wolfgang Dichtl, Hans Christoph Diener, Alexander Fierenz, Andreas Goette, Joris R de Groot, Lieven Nils Kennes, Gregory Y H Lip, Andrzej Lubinski, Eloi Marijon, Béla Merkely, Lluís Mont, Kim Rajappan, Ursula Rohrer, Andrea Sarkozy, Ulrich Schotten, Susanne Sehner, Emmanuel Simantirakis, Tobias Toennis, Panos Vardas, Vasil Velchev, Dan Wichterle, Antonia Zapf, Paulus Kirchhof
Institutions: Universität Hamburg, University Medical Center Hamburg-Eppendorf, German Centre for Cardiovascular Research, University of Applied Sciences Stralsund, Uppsala University, Örebro University, University of Southern Denmark, Hospital South West Jutland, Atrial Fibrillation NETwork, National Institute for Health and Care Research, NIHR Birmingham Biomedical Research Centre, University of Birmingham, City St George's, University of London, Hospital Prof. Dr. Fernando Fonseca, University of Crete, Carol Davila University of Medicine and Pharmacy, Innsbruck Medical University, Universität Innsbruck, Institut für Medizinische Informatik, Biometrie und Epidemiologie, University of Duisburg-Essen, Otto-von-Guericke-Universität Magdeburg, Amsterdam University Medical Centers, Amsterdam Cardiovascular Sciences, University of Amsterdam, University of Liverpool, Liverpool Heart and Chest Hospital, Liverpool John Moores University, Aalborg University, Gdańsk Medical University, Hôpital Européen Georges-Pompidou, Semmelweis University, Centro de Investigación en Red en Enfermedades Cardiovasculares, Centro de Investigación Biomédica en Red, Hospital Clínic de Barcelona, Consorci Institut D'Investigacions Biomediques August Pi I Sunyer, Universitat de Barcelona, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Medical University of Graz, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Maastricht University, University Hospital of Heraklion, Academy of Athens, Biomedical Research Foundation of the Academy of Athens, Hygeia Hospital, Medical University of Sofia, Institute of Clinical and Experimental Medicine
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,591
Awards: Auswirkungen der auf Chromosom 4q25 lokalisierten Risikoregion für Vorhofflimmern und PITX2 für Metabolismus und Mitochondrienfunktion, G4411418652, G4638203960, G5286450406, Accelerator Award, Characterizing Atrial fibrillation by Translating its Causes into Health Modifiers in the Elderly, Machine Learning Artificial Intelligence Early Detection Stroke Atrial Fibrillation, G7040426476, G8028637097, G8598010726
OpenAlex ID: W4413889221