Very-Low-Dose Edoxaban in Elderly Patients with AF

In the ELDERCARE-AF (Edoxaban Low-Dose for Elder Care Atrial Fibrillation Patients) trial, researchers found that edoxaban 15 mg once daily appeared to reduce the incidence of stroke or systemic embolism in patients with atrial fibrillation (AF). The study was published in JAMA Network Open.

In the study, very-low-dose edoxaban was compared to placebo according to frailty status. The cohort consisted of 984 Japanese patients with AF aged 80 years or more who were not eligible for oral anticoagulants (OACs) due to bleeding risk. The primary efficacy outcome was a composite of stroke and systemic embolisms, and the primary safety outcome was major bleeding events.

ELDERCARE-AF Trial: Edoxaban Treatment Outcomes

For the placebo group, the estimated event rates for stroke and systemic embolism were 7.1% (standard error [SE], 1.6%) per patient-year in frail patients and 6.1% (SE, 1.3%) per patient-year in non-frail patients. Reportedly, edoxaban was associated with reduced event rates for stroke or systemic embolism regardless of frailty parameters or status.

The edoxaban group demonstrated numerically higher rates for major bleeding and major or clinically relevant non-major bleeding events compared to the placebo group—with no heterogeneity among frailty statuses, the authors noted. In addition, all-cause death and composited outcomes were more frequent in the frail group compared to the non-frail group; However, there was no association with frailty status between the groups.

Ultimately, the authors deemed that very-low-dose edoxaban may be a treatment option for very elderly patients AF who are ineligible for standard anticoagulation, regardless of their frailty status.

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