Edoxaban Versus Vitamin K Antagonist For Atrial Fibrillation After Tavr
Atrial fibrillation (AF) is a common arrhythmia that affects millions of individuals worldwide. Transcatheter aortic valve replacement (TAVR) is a minimally invasive procedure that has been shown to improve survival in patients with severe aortic stenosis. However, AF can occur after TAVR, and anticoagulation therapy is necessary to prevent thromboembolism. The optimal anticoagulation strategy for AF after TAVR remains unclear. This article will compare the effectiveness and safety of edoxaban and vitamin K antagonists (VKAs) for AF after TAVR.
Edoxaban
Edoxaban is a direct oral anticoagulant that inhibits factor Xa. It has been approved for the prevention of stroke and systemic embolism in patients with non-valvular AF. The ENTRUST-AF PCI trial evaluated the safety and efficacy of edoxaban in patients with AF after percutaneous coronary intervention (PCI). The results showed that edoxaban was non-inferior to VKAs in preventing thromboembolic events and had a lower risk of bleeding. However, the efficacy and safety of edoxaban in patients with AF after TAVR have not been fully investigated.
Vitamin K Antagonist
Vitamin K antagonists (VKAs), such as warfarin, have been the standard anticoagulation therapy for AF for decades. VKAs inhibit the synthesis of vitamin K-dependent clotting factors, including factor II, VII, IX, and X. The efficacy and safety of VKAs have been well established in numerous clinical trials. However, VKAs have several limitations, including a narrow therapeutic window, numerous drug and food interactions, and the need for frequent monitoring of the international normalized ratio (INR).
Edoxaban Versus VKA
The ELIMINATE-AF trial compared the efficacy and safety of edoxaban and VKA in patients with AF after TAVR. The results showed that edoxaban was non-inferior to VKA in preventing stroke, systemic embolism, and major bleeding. However, edoxaban had a lower risk of intracranial bleeding and a higher risk of gastrointestinal bleeding compared to VKA. The authors concluded that edoxaban can be considered as an alternative to VKA for anticoagulation therapy in patients with AF after TAVR.
Conclusion
In conclusion, edoxaban and VKA are both effective anticoagulation therapies for AF after TAVR. Edoxaban has a lower risk of intracranial bleeding but a higher risk of gastrointestinal bleeding compared to VKA. The choice of anticoagulation therapy should be individualized based on the patient's clinical characteristics, comorbidities, and preferences. Close monitoring and management of bleeding complications are crucial in patients receiving anticoagulation therapy after TAVR.