{"id":"bebc59e8d21c","type":"article","url":"https://hartvaat.nl/2016/09/13/edoxaban-versus-warfarine-bij-af-patienten-met-valrisico-engage-af-timi-48-analy/","title":"Edoxaban versus warfarine bij AF-patiënten met valrisico: ENGAGE AF-TIMI 48-analyse","title_en":"Edoxaban Versus Warfarin in Atrial Fibrillation Patients at Risk of Falling: ENGAGE AF-TIMI 48 Analysis.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog","huisarts"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2016.06.034","source_url":"https://doi.org/10.1016/j.jacc.2016.06.034","authors":["Jan Steffel","Robert P Giugliano","Eugene Braunwald","Sabina A Murphy","Michele Mercuri","Youngsook Choi","Phil Aylward","Harvey White","Jose Luis Zamorano","Elliott M Antman","Christian T Ruff"],"significance":7,"published":"2016-09-13","source_date":"2016-09-13","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/af-bij-ouderen/","https://hartvaat.nl/kennis/antistolling/antistolling-bij-ouderen/"],"congress":"","summary_en":"This ENGAGE AF-TIMI 48 analysis showed that edoxaban maintains a favorable risk-benefit profile compared with warfarin even in AF patients at increased risk of falling, providing evidence against withholding anticoagulation based solely on perceived fall risk.","created":"2026-07-03T10:26:18Z","updated":"2026-07-03T13:25:38Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse van ENGAGE AF-TIMI 48 bij AF-patiënten met verhoogd valrisico. Relevant voor de antistollingsafweging bij ouderen waarbij valincidenten het bloedingsrisico verhogen.","abstract_original":"BACKGROUND: Anticoagulation is often avoided in patients with atrial fibrillation who are at an increased risk of falling. OBJECTIVES: This study assessed the relative efficacy and safety of edoxaban versus warfarin in the ENGAGE AF-TIMI 48 (Effective Anticoagulation with Factor Xa Next Generation in Atrial Fibrillation-Thrombolysis In Myocardial Infarction 48) trial in patients with atrial fibrillation judged to be at increased risk of falling. METHODS: We performed a pre-specified analysis of the ENGAGE AF-TIMI 48, comparing patients with versus without increased risk of falling. RESULTS: Nine hundred patients (4.3%) were judged to be at increased risk of falling. These patients were older (median, 77 vs. 72 years; p < 0.001), and had a higher prevalence of comorbidities including prior stroke/transient ischemic attack, diabetes, and coronary artery disease. After multivariable adjustment, patients at increased risk of falling experienced more bone fractures caused by falling (adjusted hazard ratio [HRadj]: 1.88; 95% confidence interval [CI]: 1.49 to 2.38; p < 0.001), major bleeding (HRadj: 1.30; 95% CI: 1.04 to 1.64; p = 0.023), life-threatening bleeding (HRadj: 1.67; 95% CI: 1.11 to 2.50; p = 0.013), and all-cause death (HRadj: 1.45; 95% CI: 1.23 to 1.70; p < 0.001), but not ischemic events including stroke/systemic embolic event (HRadj: 1.16; 95% CI: 0.89 to 1.51; p = 0.27). No treatment interaction was observed between either dosing regimens of edoxaban and warfarin for the efficacy and safety outcomes. Treatment with edoxaban resulted in a greater absolute risk reduction in severe bleeding events and all-cause mortality compared with warfarin. CONCLUSIONS: Edoxaban is an attractive alternative to warfarin in patients at increased risk of falling, because it is associated with an even greater absolute reduction in severe bleeding events and mortality. (Effective aNticaoGulation with factor xA next Generation in Atrial Fibrillation [ENGAGE AF-TIMI 48]; NCT00781391)."}