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Turkish Society of Cardiology
Young Cardiologists
President
Dr. Muzaffer Değertekin
Coordinator for the
Board of Directors
Dr. Ertuğrul Okuyan
Coordinator for the
Board of Directors
Dr. Can Yücel Karabay
Members
Dr. Adem Aktan
Dr. Gülşah Aktüre
Dr. Bayram Arslan
Dr. İnanç Artaç
Dr. Ahmet Oğuz Aslan
Dr. Görkem Ayhan
Dr. Ahmet Anıl Başkurt
Dr. Özkan Bekler
Dr. Oğuzhan Birdal
Dr. Yusuf Bozkurt Şahin
Dr. Serkan Bulgurluoğlu
Dr. Ümit Bulut
Dr. Veysi Can
Dr. Mustafa Candemir
Dr. Murat Çap
Dr. Göksel Çinier
Dr. Ali Çoner
Dr. Yusuf Demir
Dr. Ömer Furkan Demir
Dr. Murat Demirci
Dr. Ayşe İrem Demirtola Mammadli
Dr. Süleyman Çağan Efe
Dr. Mehmet Akif Erdöl
Dr. Kubilay Erselcan
Dr. Kerim Esenboğa
Dr. Duygu Genç
Dr. Kemal Göçer
Dr. Elif Güçlü
Dr. Arda Güler
Dr. Duygu İnan
Dr. Hasan Burak İşleyen
Dr. Muzaffer Kahyaoğlu
Dr. Sedat Kalkan
Dr. Yücel Kanal
Dr. Özkan Karaca
Dr. Ahmet Karaduman
Dr. Mustafa Karanfil
Dr. Ayhan Kol
Dr. Fatma Köksal
Dr. Mevlüt Serdar Kuyumcu
Dr. Yunus Emre Özbebek
Dr. Ahmet Özderya
Dr. Yasin Özen
Dr. Ayşenur Özkaya İbiş
Dr. Çağlar Özmen
Dr. Selvi Öztaş
Dr. Hasan Sarı
Dr. Serkan Sivri
Dr. Ali Uğur Soysal
Dr. Hüseyin Tezcan
Dr. Nazlı Turan
Dr. Berat Uğuz
Dr. Örsan Deniz Urgun
Dr. İdris Yakut
Dr. Mustafa Yenerçağ
Dr. Mehmet Fatih Yılmaz
Dr. Yakup Yiğit
Dr. Mehmet Murat Yiğitbaşı
Bulletin Editors
Dr. Muzaffer Değertekin
Dr. Can Yücel Karabay
Dr. Muzaffer Kahyaoğlu
Dr. Ahmet Karaduman
Contributors
Dr. Ahmet Karaduman
Dr. Berkant Öztürk
Dr. Burak Kardeşler
Dr. Kıvanç Eren
Dr. Mehmet Aydoğan
Dr. Murat Demirci
Dr. Murat Yiğitbaşı
Dr. Mustafa Candemir
Dr. Mustafa Lütfi Yavuz
Dr. Mustafa Yenerçağ
Dr. Ravza Betül Akbaş
Dr. Selvi Öztaş
Dr. Serkan Bulgurluoğlu
Dr. Yunus Çalapkulu
Dr. Yusuf Bozkurt
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Asundexian versus Apixaban in Patients with Atrial FibrillationTürk Kardiyoloji Derneği Genç Kardiyologlar Bülteni - Asundexian versus Apixaban in Patients with Atrial Fibrillation (Dr. Mustafa Candemir)Dr. Mustafa Candemir
Asundexian versus Apixaban in Patients with Atrial Fibrillation
ESC 2024
Link: FULL TEXT
https://www.nejm.org/doi/full/10.1056/NEJMoa2407105
Background
Oral anticoagulants used to prevent stroke in patients with atrial fibrillation may be restricted because of the increased risk of bleeding. Asundexian is considered an oral anticoagulant with a lower bleeding profile while reducing the risk of stroke as an activated factor XI (XIa) inhibitor.
Methods
In a phase 3, international, double-blind study, high-risk patients with atrial fibrillation were randomly assigned 1:1 into two groups: one group received 50 mg of asundexian once daily, and the other group received a standard dose of apixaban. The primary objective was to determine whether asundexian was at least equally effective to apixaban in preventing stroke or systemic embolism. It was also assessed whether asundexian was superior to apixaban in terms of major bleeding events.
Results
A total of 14,810 patients were included in the intent-to-treat analysis. The mean patient age was 73.9 years, 35.2% were female, 18.6% had chronic kidney disease, 18.2% had a history of previous stroke or transient ischemic attack, 16.8% were receiving oral anticoagulant therapy, and the mean CHA2DS2-VASc score was 4.3. The study was terminated early on the recommendation of the Independent Data Monitoring Committee. Stroke or systemic embolism occurred in 98 patients (1.3%) receiving asundexian, compared with 26 patients (0.4%) receiving apixaban (risk ratio, 3.79; 95% confidence interval [CI], 2.46 to 5.83). Major bleeding was observed in 17 patients (0.2%) receiving asundexian and 53 patients (0.7%) receiving apixaban (risk ratio 0.32; 95% CI, 0.18 to 0.55). The incidence of all adverse events was similar in both groups.
Conclusions
In patients with atrial fibrillation at risk for stroke, asundexian 50 mg once daily was associated with a higher incidence of stroke or systemic embolism compared to apixaban. However, fewer major bleeding events were observed with asundexian during this period.
Comment
More research is needed to determine whether the concept of factor XIa inhibition may become an option for stroke prevention in patients with atrial fibrillation and, if so, in which population and what degree of factor XIa inhibition is necessary to effectively and safely achieve this.
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