{"id":"678f5b88f17f","type":"article","url":"https://hartvaat.nl/2017/03/21/nieuwe-risicovoorspellingsscore-bij-af-voor-netto-klinisch-resultaat-engage-af-t/","title":"Nieuwe risicovoorspellingsscore bij AF voor netto klinisch resultaat: ENGAGE AF-TIMI 48","title_en":"A novel risk prediction score in atrial fibrillation for a net clinical outcome from the ENGAGE AF-TIMI 48 randomized clinical trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehw565","source_url":"https://doi.org/10.1093/eurheartj/ehw565","authors":["Christina L Fanola","Robert P Giugliano","Christian T Ruff","Marco Trevisan","Francesco Nordio","Michele F Mercuri","Elliott M Antman","Eugene Braunwald"],"significance":6,"published":"2017-03-21","source_date":"2017-03-21","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/edoxaban/"],"congress":"","summary_en":"This ENGAGE AF-TIMI 48 analysis developed a novel risk score for net clinical outcome (combining ischemic and bleeding events) in AF, helping guide the choice between DOAC and VKA therapy based on individual patient characteristics.","created":"2026-07-03T10:26:36Z","updated":"2026-07-03T13:25:55Z","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":"Ontwikkeling van een nieuwe risicoscore voor het netto klinisch resultaat (ischemie + bloedingen) bij AF vanuit de ENGAGE AF-TIMI 48-trial. Geïntegreerde risicostratificatie.","abstract_original":"AIMS: The choice between initiating a non-vitamin K antagonist oral anticoagulant (NOAC) and a vitamin K antagonist (VKA) in patients with atrial fibrillation (AF) may be challenging. To assist in this decision, we developed a risk score to identify patients for whom a therapeutic benefit of NOACs over VKA is predicted. METHODS AND RESULTS: ENGAGE AF-TIMI 48 was a randomized clinical trial of edoxaban vs. warfarin in 21 105 patients with AF. Cox proportional hazard models identified factors associated with a serious net clinical outcome (NCO) of disabling stroke, life-threatening bleeding, and all-cause mortality in VKA naïve patients from the warfarin arm. These were used to develop an integer risk score. Performance was assessed by C-indices and validation by bootstrapping. Kaplan-Meier analyses were stratified by three score categories and treatment arm. Over a median of 2.7 years, 457 NCO events occurred in 2898 patients with a total person-time of 7549.5 years (6.05%/year). The risk prediction model (C = 0.693) for the NCO was translated into a 17-point integer score, with annualized event rates for the low, intermediate, and high-risk categories in the warfarin arm of 3.5%, 9.9%, and 20.8%, respectively. Therapeutic benefit of higher- and lower-dose edoxaban over warfarin was demonstrated in the high- and intermediate-risk, with equal benefit in the low-risk categories (P-interaction 0.008 and 0.014, respectively). CONCLUSION: In VKA naive patients with AF, the TIMI-AF score can assist in the prediction of a poor composite outcome and guide selection of anticoagulant therapy by identifying a differential clinical benefit with a NOAC or VKA."}