Laboratory Test Predictors for Major Bleeding in Elderly (≥80 Years) Patients With Nonvalvular Atrial Fibrillation Treated With Edoxaban 15 mg: Sub-Analysis of the ELDERCARE-AF Trial

Takeshi Mikami, Kagami Hirabayashi, Keisuke Okawa, Tetsuo Betsuyaku, Saori Watanabe, Yuki Imamura, Kimihiko Tanizawa, Takuya Hayashi, Masaharu Akao, Takeshi Yamashita, Ken Okumura, Takeshi Mikami, Kagami Hirabayashi, Keisuke Okawa, Tetsuo Betsuyaku, Saori Watanabe, Yuki Imamura, Kimihiko Tanizawa, Takuya Hayashi, Masaharu Akao, Takeshi Yamashita, Ken Okumura

Abstract

Background We investigated the predictors related to major bleeding events during treatment with edoxaban 15 mg in patients aged ≥80 years with nonvalvular atrial fibrillation and high bleeding risk, for whom standard oral anticoagulants are inappropriate, focusing on standard laboratory tests related to bleeding. Methods and Results This was a prespecified subanalysis of the on-treatment analysis set of the ELDERCARE-AF (Edoxaban Low-Dose for Elder Care Atrial Fibrillation Patients) trial. Major bleeding was the primary safety end point. The event rates were calculated according to prespecified characteristics at baseline. A total of 984 Japanese patients were randomly assigned to edoxaban 15 mg or placebo (n=492, each). During the study period, 20 and 11 major bleeding events occurred in the edoxaban and placebo groups, respectively. The adjusted analysis revealed that hemoglobin <12.3 g/dL (adjusted hazard ratio [aHR], 3.57 [95% CI, 1.10-11.55]) and prothrombin time ≥12.7 seconds; (aHR, 2.89 [95% CI, 1.05-8.02]) independently predicted major bleeding, while creatinine clearance <30 mL/min showed a tendency towards an increase in major bleeding (aHR, 2.68; 95% CI, 0.96-7.46). In patients treated with edoxaban lacking these 3 risk factors, no major bleeding occurred; major bleeding event rates increased with each risk factor. Patients with 3 risk factors were significantly more likely to have a major bleeding event at 11.05%/year (HR, 7.15 [95% CI, 1.92-26.71]). Conclusions In elderly patients with nonvalvular atrial fibrillation with high bleeding risk, baseline hemoglobin <12.3 g/dL, prothrombin time ≥12.7 seconds, and creatinine clearance <30 mL/min may predict major bleeding during treatment with edoxaban 15 mg. Registration URL: ELDERCARE-AF https://www.clinicaltrials.gov; Unique number: NCT02801669.

Keywords: atrial fibrillation; creatinine clearance; edoxaban; elderly; hemoglobin; hemorrhage; prothrombin time.

Figures

Figure 1. aplan–Meier curves for major bleeding…
Figure 1. aplan–Meier curves for major bleeding events by subgroups according to (A) creatinine clearance, (B) hemoglobin, and (C) prothrombin time.
Blue and red lines in each panel indicate the patient groups with and without each bleeding risk factor, respectively. aHR indicates adjusted hazard ratio; CrCl, creatinine clearance; and PT, prothrombin time.

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