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News from the ESC 2016

We report the anticoagulation highlights from this key event in the cardiology calendar – the European Society of Cardiology (ESC) Congress – in this special edition of Arrhythmia Watch. Taking place in Rome, Italy, from 27th -31st August 2016, it attracted over 33,000 delegates from across the globe, including His Holiness Pope Francis. Studies selected for the much anticipated Hotline sessions included the ENSURE AF study looking at the use of edoxaban in cardioversion and the ANNEXA-4 study for reversal of acute bleeding.

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News from the ESC 2016


ENSURE AF: edoxaban allows prompt cardioversion in AF

ENSURE AF: edoxaban allows prompt cardioversion in AF

Patients with atrial fibrillation (AF) who need anticoagulation before undergoing cardioversion may benefit from treatment with the non-vitamin K antagonist oral anticoagulant (NOAC), edoxaban, compared to best possible conventional therapy (warfarin and enoxaparin), according to results from the ENSURE-AF study presented during a hotline session at the meeting.

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Commentary on ENSURE-AF

Commentary on ENSURE-AF

British Junior Cardiologists Association (BJCA) President, Dr Jubin Joseph, who is also British Heart Foundation Clinical Research Fellow, at St Thomas’ Hospital, London, discussed ENSURE AF in our podcast (click here to view).

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ANNEXA 4: reversal agent shows efficacy in acute bleeding

ANNEXA 4: reversal agent shows efficacy in acute bleeding

Preliminary results in the ongoing ANNEXA-4 study have shown that andexanet can rapidly reverse anti-factor Xa activity in acutely bleeding patients and is associated with excellent or good haemostasis in most.

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New ESC/EACTS guidelines for the management of AF

New ESC/EACTS guidelines for the management of AF

The first collaborative ESC and European Association for Cardio-Thoracic Surgery (EACTS) Guidelines on Atrial Fibrillation (AF) were published at the start of ESC Congress.1 These multidisciplinary guidelines focus on early detection of asymptomatic AF, recommending both opportunistic and targeted screening for all patients aged ≥65 years, or with stroke or transient ischaemic attack (TIA).

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‘True’ costs of NOACs assessed

‘True’ costs of NOACs assessed

Health economic studies are now assessing the true costs of non-vitamin K antagonist oral anticoagulants (NOACs) compared to warfarin. One study presented at the congress by Dr Elizabeth A Magnuson (Saint Luke’s Mid-America Heart Institute, Kansas City, USA) showed that compared with warfarin, edoxaban 60 mg (30 mg dose-reduced) once daily significantly reduced the overall rate of cardiovascular complications and bleeding-related hospitalisations and associated hospitalisation costs. 1

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Smartphone monitoring detects atrial fibrillation

Smartphone monitoring detects atrial fibrillation

Smartphones can be used to detect atrial fibrillation (AF) with existing hardware, according to research presented by Mr Tero Koivisto (University of Turku, Finland).1

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Historic Papal visit to Congress

Historic Papal visit to Congress

His Holiness Pope Francis was delighted to receive a stethoscope from the ESC during his historic visit to the Congress. He was welcomed by ESC President Fausto Pinto. “I thank each of you for the scientific work in these days of study and discussion, but above all for your dedication to so many who are sick,” the Pope said in his address to delegates.

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Sponsorship statement

The writing of this report was sponsored by Daiichi-Sankyo. The company had no input into the content of the report but did examine it for ABPI compliance before publication.

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More real world data for OAC therapy

There are many challenges for physicians in managing patients with atrial fibrillation (AF). This has led to increasing interest in registry data giving insights into the real-world use of oral anticoagulation in non-valvular AF (NVAF). Below we highlight some of the registry data presented at this year’s congress

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UK patients not receiving anticoagulants properly

While oral anticoagulation (OAC) is recommended for the majority of patients with atrial fibrillation (AF) and ≥1 risk factor for stroke, OACs are not being prescribed for UK patients as per guidelines. This was the finding from a retrospective analysis of 105,000 patients enrolled into an observational community-based registry of 11 general practices (GP) serving the town of Darlington, England.

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Special groups: diabetes

Data from the PREFER in AF patient registry has shown that patients with atrial fibrillation (AF) and diabetes on insulin treatment are at a significantly increased risk of stroke/systemic embolism compared to both AF patients without diabetes and AF patients with diabetes but not on insulin treatment.1

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Special groups: gender

The PREFER in AF registry has also shown that women experience a greater burden of symptoms compared to men and that treatment with oral anticoagulation is similar in both genders.1

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Special groups: body mass index

Analysis of the ENGAGE AF –TIMI study has shown that obese patients with atrial fibrillation (AF) had a lower risk of stroke/systemic embolic events (SEE) and better survival than AF patients with a normal body mass index (BMI), but the risk of bleeding was higher in patients with a BMI ≥ 25.1

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Stopping oral anticoagulation increases stroke risk

Oral anticoagulation (OAC) is highly effective in reducing thromboembolism and mortality in atrial fibrillation (AF) and stopping OAC significantly increases risk of stroke and mortality. This is the principal finding from a study conducted by Dr Jose Miguel Rivera-Caravaca (Hospital Universitario Virgen de la Arrixaca, Murcia, Spain) and co-workers.1

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New risk scoring systems better identify AF patients for anticoagulation


While existing risk scores help identify patients with atrial fibrillation (AF) who warrant anticoagulation and monitoring, none are able to predict those who are likely to have adverse effects with warfarin and thus likely to benefit from non-vitamin K antagonist oral anticoagulation (NOAC) therapy. The ENGAGE-AF TIMI risk score addressed this issue, using data from 21,105 patients from the trial with CHADS2 ≥2.1

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  • ArrhythmiaAlliance
  • Stars
  • Anticoagulation Europe
  • Atrial Fibrillation Association

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