Early edoxaban may be safe after cardioembolic stroke

The optimal timing for starting oral anticoagulation after a stroke or transient ischaemic attack (TIA) in patients with nonvalvular atrial fibrillation (NVAF) is unknown. The observational SATES study of early treatment with edoxaban showed early initiation of edoxaban seems to be safe after a cardioembolic stroke [1].

New direct oral anticoagulants (DOACs), of which edoxaban is an example, are recommended for stroke prevention in NVAF patients. SATES was a prospective study to evaluate the safety of initiation within 72 hours of full dose edoxaban in NVAF patients after acute ischaemic stroke. The primary endpoint was safety in terms of any major bleeding in the first 3 months of treatment. Secondary endpoints were incidence of major bleeding, haemorrhagic transformation, and symptomatic haemorrhagic transformation rate, 3±2 days after the start of edoxaban treatment.

A total of 50 patients were enrolled, with a mean age of 77 years and a mean NIH Stroke Scale/Score of 7.8. After 3 months, only one major bleeding (gastrointestinal bleeding) was reported, which resulted in a temporary suspension of edoxaban use; there were also 8 minor bleedings, without recurrence of stroke. There was no major bleeding or symptomatic haemorrhagic transformation in the first 3±2 treatment days; the incidence rate of haemorrhagic transformation was 12% for haemorrhagic infarction (HI)-1 (small petechiae) and 8% for HI-2 (confluent petechiae) without neurological deterioration. All patients continued edoxaban after 3 months.

1. Frisullo G, et al. Abstract O1031, EAN 2020.

 

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Posted on 9 September, 202028 October, 2020