Cardiology

Comparing TEE vs Non-TEE guided cardioversion of atrial fibrillation: the ENSURE-AF trial.




Comparing TEE vs Non-TEE guided cardioversion of atrial fibrillation: the ENSURE-AF trial.

Eur J Clin Invest. 2020 Mar 09;:e13221

Authors: Kozieł M, Merino JL, De Caterina R, Huber K, Jin J, Melino M, Goette A, Lip GYH, ENSURE-AF Investigators

Abstract
BACKGROUND: ENSURE-AF (NCT02072434) assessed therapy with edoxaban versus enoxaparin-warfarin in patients with nonvalvular atrial fibrillation (AF) undergoing elective electrical cardioversion (ECV).
OBJECTIVES: To evaluate clinical features and primary efficacy (composite of stroke, systemic embolic events, myocardial infarction and cardiovascular mortality during study period) and safety endpoints (composite of major and clinically relevant nonmajor bleeding during on-treatment period) in patients awaiting ECV of AF with a transesophageal echocardiography (TEE)-guided versus a non-TEE guided strategy.
METHODS: In this prospective randomized open-label blinded endpoint study, 2199 patients were randomized to edoxaban 60 mg once daily (30 mg for creatinine clearance 15-50 mL/min, weight ≤60 kg, and/or concomitant use of P-glycoprotein inhibitor) or enoxaparin-warfarin. Primary efficacy endpoint and safety endpoint were reported. Associates of TEE use, efficacy endpoint and safety endpoint were explored using multivariable logistic regression.
RESULTS: In total, 589 patients from the edoxaban stratum and 594 from the enoxaparin-warfarin stratum were allocated to the TEE-guided strategy. Primary efficacy was similar regardless of TEE approach (p = 0.575). There were no significant differences in bleeding rates, regardless of TEE approach (p = 0.677). Independent predictors of TEE use were: history of ischaemic stroke/ transient ischaemic attack, hypertension and valvular heart disease. Mean CHA2 DS2 VASc and HAS-BLED score were independent predictors of the efficacy endpoint whilst mean age was an independent predictor of the safety endpoint.
CONCLUSIONS: Thromboembolic and bleeding events were not different between patients undergoing TEE-guided strategy and in those undergoing an optimized conventional anticoagulation approach for ECV of AF.

PMID: 32150758 [PubMed - as supplied by publisher]

Source link







Related posts

Advanced diffusion imaging for assessing normal white matter development in neonates and characterizing aberrant development in congenital heart disease.

Newsemia

Mineralocorticoid Receptor Antagonists, Blood Pressure, and Drug Discontinuation.

Newsemia

Coronary Artery Bypass Grafting in Acute Ischemic Heart Failure: Where do We Stand? (And Where Should We Go?).

Newsemia

This website uses cookies to improve your experience. We'll assume you're ok with this, but you can opt-out if you wish. Accept Read More

Privacy & Cookies Policy