Increasing Very Low-Dose Edoxaban Prescription: Effectiveness and Safety Data of Korean AF Patients

초록

Background and Objectives: Evidence remains limited on the real-world prescription ofvery low-dose oral anticoagulation among frail patients with atrial fibrillation (AF). We described the practice patterns, effectiveness, and safety of very low-dose edoxaban (15 mg once daily). Methods: Patients with AF prescribed edoxaban 15 mg once daily in 2 tertiary hospitals between 2016 and September 2022 were included. Baseline clinical characteristics and clinical outcomes of interest were thromboembolic and bleeding events. Results: A total of 674 patients were included (mean age 78.3 +/- 9.1, 49.7% aged >= 80 years, 49.3% women, median follow-up 1.0 +/- 1.2 years). Mean CHA2DS2-VASc score was 3.9 +/- 1.6, and the modified HAS-BLED score was 2.0 +/- 1.1. Between 2016 and 2022, the number ofvery low- dose edoxaban prescriptions increased. The main reasons for the prescription of very low- dose were low body weight (55.5% below 60 kg), anaemia (62.8%), chronic kidney disease (40.2%), active cancer (15.3%), concomitant anti-platelet use (26.7%), and prior major bleeding (19.7%). During a median follow-up duration of 8 (interquartile range 3-16) months, overall thromboembolic and bleeding events occurred in 16 (2.3%) and 88 (13.1%) patients, respectively. Compared to the expected event rates on the established risk scoring systems, patients receiving very low-dose edoxaban demonstrated a 61% reduction in ischemic stroke, a 68% reduction of ischemic stroke/transient ischemic attack/systemic embolism, whereas a 49% increase in major bleeding. Conclusions: The prescription ofvery low-dose edoxaban was increased over time, attributable to various clinical factors. The use ofvery low-dose edoxaban reduced the expected risk of thromboembolic events.

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