Real-life use of edoxaban (Lixiana®, Daiichi Sankyo) in Asian atrial fibrillation (AF) patients significantly lowered the risk of ischaemic stroke (IS), intracranial haemorrhage (ICH), hospitalisation for gastrointestinal (GI) bleeding, hospitalisation for major bleeding, and all-cause death when compared to warfarin. This was concluded by the Korean investigators in the Journal of the American College of Cardiology. The benefits were consistent in the various high-risk subgroups.

The study registered new AF patients with prescriptions for either edoxaban (n=4,200) or warfarin (n=31,565) from the Korean National Health Insurance Service database. A propensity score matching method for edoxaban vs warfarin users balanced the covariates across the groups. The investigators analysed the risk of IS, ICH, hospitalisation for GI or major bleeding, and all-cause death.

The 1:3 propensity score−matched cohort of Korean AF patients encompassed 4,061 edoxaban and 12,183 warfarin users. Baseline characteristics were balanced between the two groups for age and CHA₂DS₂-VASc score (score 3).

Use of edoxaban was associated with a significantly decreased risk of IS (HR=0.693; 95% CI, 0.487-0.959), ICH (HR=0.407; 95% CI, 0.182-0.785), hospitalisation for GI bleeding (HR=0.597; 95% CI, 0.363-0.930), hospitalisation for major bleeding (HR=0.532; 95% CI, 0.352-0.773), and all-cause death (HR=0.716; 95% CI, 0.549-0.918) when compared to warfarin. Moreover, the improved clinical outcomes with edoxaban vs warfarin were consistent across all subgroups (age, sex, CHA₂DS₂-VASc score, renal function, edoxaban dose).

References

Lee SR, et al. J Am Coll Cardiol 2018: DOI: 10.1016/j.jacc.2018.05.066