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Terapia anticoagulante, con LIXIANA® meno emorragie intracraniche rispetto al warfarin

Roma 18 maggio 2018 - Una nuova sotto-analisi del trial ENGAGE AF-TIMI 48 dimostra che i pazienti affetti da fibrillazione atriale trattati con edoxaban per la prevenzione di ictus o eventi embolici sistemici presentano una frequenza di diverse tipologie di emorragie intracraniche inferiore rispetto ai pazienti con la stessa patologia trattati con warfarin. I dati sono stati presentati da Daiichi Sankyo durante il Congresso dell'European Stroke Organisation (ESOC), in corso a Göteborg, in Svezia.

L'emorragia intracranica è una tipologia di sanguinamento che si verifica all'interno del cranio, e può verificarsi sia nel parenchima cerebrale che negli spazi intermeningei che lo circondano, con danni potenzialmente gravi e permanenti per i pazienti e mortalità tre volte superiore all'ictus ischemico. Questa nuova sotto-analisi dell'ENGAGE AF-TIMI 48 ha valutato le diverse tipologie di emorragie intracraniche, evidenziando una riduzione del 42% di emorragie intracraniche spontanee (HR 0,58 [0,41-0,81]) e del 62% di quelle traumatiche (HR 0.38 [0.23-0.63]) tra i pazienti che assumevano edoxaban (60mg o dose ridotta a 30mg, in monosomministrazione giornaliera) rispetto a coloro che erano trattati con warfarin. Nella stessa sottoanalisi, inoltre, gli outcome di edoxaban in confronto con il warfarin hanno evidenziato una frequenza inferiore di emorragie intraparenchimali (HR 0,55 [95% CI 0,38-0,78]) ed ematomi subdurali (HR 0,36 [0,22-0,58]), e simile frequenza di emorragia subaracnoidea e ictus ischemico con trasformazione emorragica (entrambi p>0.05).

"Gli anticoagulanti orali non antagonisti della vitamina K sono sempre più usati nella pratica clinica, perciò è essenziale proseguire nell'impegno di espandere la conoscenza di queste terapie in specifiche popolazioni di pazienti, al fine di ottimizzare e migliorare la cura - ha dichiarato il co-autore dello studio Robert P. Giugliano, Dipartimento di Medicina Cardiovascolare del Women's Hospital di Brigham, Harvard Medical School di Boston - E i risultati di questa sotto-analisi suggeriscono che edoxaban offra un vantaggio rispetto al warfarin nei pazienti anticoagulati a rischio di emorragie intracraniche, e allo stesso tempo forniscono ai medici una ulteriore guida e garanzia al suo uso".

I risultati di quest'ultima analisi dall'ENGAGE AF-TIMI 48 sono in linea con le raccomandazioni contenute nella guida all'uso degli anticoagulanti orali non-antagonisti della vitamina K nei pazienti con FA, stilata nel 2018 dall' European Heart Rhythm Association. Le linee guida raccomandano l'uso degli anticoagulanti orali diretti rispetto al warfarin, per la prevenzione dell'ictus in pazienti eleggibili affetti da FA, proprio grazie al rischio ridotto di emorragie intracraniche e potenzialmente mortali osservato costantemente in numerosi studi. "Questi dati accrescono il corpus di evidenze scientifiche che supportano l'uso di edoxaban nella pratica clinica e confermano i risultati del trial ENGAGE-AF-TIMI 48- ad oggi il più ampio e lungo trial singolo comparativo globale sull'uso di un NAO in pazienti con fibrillazione atriale non valvolare - in cui edoxaban ha dimostrato la non inferiorità rispetto al warfarin per la prevenzione di ictus ed eventi embolici sistemici nei soggetti con FA, con inoltre una significativa riduzione della mortalità cardiovascolare e dei sanguinamenti maggiori." ha commentato il dott. Wolfgang Zierhut, ricercatore e Capo dell'area terapie antitrombotiche e cardiovascolari di Daiichi Sankyo Europa.