Bayer symposium highlights from the ESC congress 2021
During the Bayer sponsored symposium at the ESC congress 2021, the panel of experts explored some of the issues and treatment considerations applicable to patients with AF who have diabetes, renal dysfunction, or who are ageing:
RIVA-DM: Protecting patients with AF and diabetes from stroke1
The first talk of the symposium by Prof Coleman and Dr Patel focused on the influence of diabetes on a patient’s risk of adverse outcomes, including ESKD and MALE. Using new data from the recent RIVA-DM study, they demonstrated that, vs warfarin, Xarelto®:
Discover more: the use of anticoagulation in patients with AF and diabetes
GARFIELD-AF study – analysis of a registry investigating the effectiveness and safety of using NOACs in patients with AF, with or without diabetes, showed reductions in risk of death and stroke/SE were similar for both patient groups. A similar increase in major bleeding was also seen in patients at high risk of bleeding, or with impaired kidney function.3
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Meta-analysis and systematic review – patients with AF, with or without diabetes, who were being treated with NOACs revealed similar rates of stroke/SE, stroke and all-cause mortality in patients with diabetes compared with those without diabetes.4
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Click here to view an infographic developed by Bayer on the RIVA-DM study.
ANTENNA: Preserving kidney function matters to patients with AF and renal impairment
The second presentation of the Bayer symposium was hosted by Dr Kreutz and Dr Patel, who set out the challenges associated with the management of a patient with AF and kidney impairment. Using highly anticipated Real-World Evidence from the ANTENNA study, they shared how adverse kidney outcomes are reduced in patients with AF newly treated with Xarelto vs warfarin.5
Accumulating retrospective data suggest that Xarelto may help to preserve kidney function in patients with AF, AF and kidney impairment, and AF and diabetes, vs warfarin.
Click here to view an infographic developed by Bayer on the ANTENNA study.
Discover more: managing patients with AF and kidney impairment
XARENO study – an ongoing prospective registry of patients with kidney dysfunction who are usually excluded from clinical trials. The findings will provide important information on the effect of anticoagulant choice upon kidney function.6
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Cohort analysis – ain patients with newly diagnosed AF treated with NOACs, more patients with kidney function decline experienced AF progression, major adverse CV events, and major bleeding than patients without kidney function decline.7
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Meta-analysis and systematic review – tudies investigating NOAC use vs warfarin use in patients with stage IV–V chronic kidney disease showed that NOACs are associated with reductions in stroke/SE, intracranial bleeding, and haemorrhagic stroke, vs warfarin.8
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RIVER study – inappropriate use of low-dose Xarelto (<20 mg OD) in patients with AF with normal kidney function was associated with a higher risk of non-CV mortality, without reducing bleeding. Patients with moderate-to-severe kidney impairment treated with non-recommended doses of Xarelto had a lower risk of CV mortality, but a higher risk of all-cause mortality and major bleeding.9
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EMIR: Maintaining protection – benefit–risk assessment in the elderly10
With an ageing population and age being a risk factor for both stroke and bleeding, Prof Collins and Dr Patel reminded the audience that the guidelines state that frailty, falls and dementia are not contraindications for oral anticoagulant use. Indeed, better outcomes are indicated with the use of NOACs in ageing patients compared with VKA.
In a sub-analysis of the prospective, observational EMIR study, Prof Collins reported that patients with AF aged ≥75 years and treated with Xarelto experienced higher rates of adverse events compared with younger patients.10 These included:10
Importantly, however, these rates are lower than those seen in previous studies, such as ROCKET AF and XANTUS.10–12
Discover more: maintaining protection in elderly populations with AF
Retrospective study – older patients with AF from Taiwan showed that low-dose Xarelto (15 mg OD) was associated with reduced rates of all-cause mortality in patients aged ≥85 years compared with standard dose (20 mg OD). No all-cause mortality benefit was seen in those aged <85 years.*,13
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Database analysis – in Korea, patients with AF aged ≥80 years treated with NOACs were associated with better efficacy outcomes than patients not treated with OACs, but were at a greater risk of major bleeding.14
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Systematic review – patients aged ≥80 years treated with NOACs were associated with risk reductions in stroke, all-cause mortality, and intracranial bleeding vs patients taking VKAs. Rates of major bleeding and gastrointestinal bleeding were similar between treatment groups.15
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Dosing – underdosing of NOACs in patients with AF aged ≥85 years was associated with increased risk of stroke/SE, with no reduction in bleeding events, vs warfarin. Overdosing of NOACs provided no additional protection against stroke/SE, with no increase in bleeding events, vs warfarin.16
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GARFIELD-AF study – an analysis of patients with AF aged ≥75 years highlighted a reduction in all-cause mortality with the use of NOACs vs VKAs. NOACs were also favourable to VKAs in patients at high risk of bleeding or impaired kidney function.17
Explore the study
AF, atrial fibrillation; CI, confidence interval; CV, cardiovascular; eGFR, estimated glomerular filtration rate; ESC, European Society of Cardiology; ESKD, end-stage kidney disease; HR, hazard ratio;
MALE, major adverse limb events; NOAC, non-vitamin K antagonist oral anticoagulant; OAC, oral anticoagulant; OD, once daily; SE, side effect; VKA, vitamin K antagonist.
* Please note, the doses used in this study may not be recommended for all countries.
- Coleman CI et al. Cardiovasc Diabetol 2021;20:52. Return to content
- Costa OS et al. EHRA. 2021. 23-25 April 2021. Poster. Return to content
- Bassand JP et al. Future Cardiol 2020;e19–38. doi:10.2217/fca-2020-0014. Return to content
- Kreutz R et al. Eur Heart J 2020;22:O78–O86. Return to content
- Lenz Y et al. ESC Congress. Virtual, 27–31 August 2021. Poster. https://esc2021-abstract.medicalcongress.online/mediatheque/media.aspx?channel=103467&mediaId=104597 [accessed 5 October 2021]. Lenz Y et al. ESC Congress. Virtual, 27–31 August 2021. Poster. https://esc2021-abstract.medicalcongress.online/mediatheque/media.aspx?channel=103467&mediaId=104597 [accessed 5 October 2021]. Return to content
- ClinicalTrials.gov. Factor XA - Inhibition in RENal Patients With Non-valvular Atrial Fibrillation - Observational Registry (XARENO). NCT02663076. Return to content
- Bartoli L et al. ESC Congress. Virtual, 27–31 August 2021. Presentation. https://esc365.escardio.org/presentation/236233 [accessed 7 October 2021]. Bartoli L et al. ESC Congress. Virtual, 27–31 August 2021. Presentation. https://esc365.escardio.org/presentation/236233 [accessed 7 October 2021]. Return to content
- Wartanian A et al. ESC Congress. Virtual, 27–31 August 2021. Presentation. https://esc365.escardio.org/presentation/236094 [accessed 7 October 2021]. Wartanian A et al. ESC Congress. Virtual, 27–31 August 2021. Presentation. https://esc365.escardio.org/presentation/236094 [accessed 7 October 2021]. Return to content
- Camm AJ et al. ESC Congress. Virtual, 27–31 August 2021. Presentation. https://esc365.escardio.org/presentation/236128 [accessed 7 October 2021]. Camm AJ et al. ESC Congress. Virtual, 27–31 August 2021. Presentation. https://esc365.escardio.org/presentation/236128 [accessed 7 October 2021]. Return to content
- Esteve Pastor M et al. ESC Congress. Virtual, 27–31 August 2021. Poster. https://esc365.escardio.org/presentation/237373 [accessed 7 October 2021]. Esteve Pastor M et al. ESC Congress. Virtual, 27–31 August 2021. Poster. https://esc365.escardio.org/presentation/237373 [accessed 7 October 2021]. Return to content
- Patel MR et al. N Engl J Med 2011;365(10):883–91. Return to content
- Camm AJ et al. Eur Heart J 2016;37 :1145–1153. Return to content
- Tsai CT et al. Eur J Clin Invest 2021;00:e13488. Return to content
- Lee SR et al. ESC Congress. Virtual, 27–31 August 2021. Presentation. https://esc365.escardio.org/presentation/236776 [accessed 7 October 2021]. Lee SR et al. ESC Congress. Virtual, 27–31 August 2021. Presentation. https://esc365.escardio.org/presentation/236776 [accessed 7 October 2021]. Return to content
- Bonanad C et al. ESC Congress. Virtual, 27–31 August 2021. Presentation. https://esc365.escardio.org/presentation/237321 [accessed 7 October 2021]. Bonanad C et al. ESC Congress. Virtual, 27–31 August 2021. Presentation. https://esc365.escardio.org/presentation/237321 [accessed 7 October 2021]. Return to content
- Chao T et al. ESC Congress. Virtual, 27–31 August 2021. Presentation. https://esc365.escardio.org/presentation/236164 [accessed 7 October 2021]. Chao T et al. ESC Congress. Virtual, 27–31 August 2021. Presentation. https://esc365.escardio.org/presentation/236164 [accessed 7 October 2021]. Return to content
- Virdone S et al. ESC Congress. Virtual, 27–31 August 2021. Presentation. https://esc365.escardio.org/presentation/236127 [accessed 7 October 2021]. Virdone S et al. ESC Congress. Virtual, 27–31 August 2021. Presentation. https://esc365.escardio.org/presentation/236127 [accessed 7 October 2021]. Return to content
- Yamashita T. ESC Congress. Virtual, 27–31 August 2021. Presentation. https://esc365.escardio.org/presentation/236116 [accessed 7 October 2021]. Yamashita T. ESC Congress. Virtual, 27–31 August 2021. Presentation. https://esc365.escardio.org/presentation/236116 [accessed 7 October 2021]. Return to content
See Also
Anticoagulation in high risk patients with atrial fibrillation – Episode 1
See Also
Atrial fibrillation in patients with diabetes and renal impairment
See Also
Stroke prevention in older patients: How can you protect those who need it most?
See Also
When is the right time to start thinking about renal function in patients with AF?
See Also
Patients with diabetes and atrial fibrillation: How can the risk of cardiovascular death be reduced?
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