New 12-month analysis data from ETNA-AF non-interventional study show low bleeding and ICH rates in frail and ageing AF patients on LIXIANA®▼ (edoxaban) during routine clinical care

New 12-month analysis data from ETNA-AF non-interventional study show low bleeding and ICH rates in frail and ageing AF patients on LIXIANA®▼ (edoxaban) during routine clinical care

PR Newswire

MUNICH, Aug. 31, 2020

Newly presented data provide reassurance around edoxaban use in vulnerable populations of frail, ageing and renally impaired patients

Clinician's perception of frailty found to potentially be a better marker of clinical outcomes than age

The global ETNA-AF programme, which includes ETNA-AF-Europe, is the largest prospective, non-interventional study investigating a single DOAC to date

MUNICH, Aug. 31, 2020 /PRNewswire/ -- Daiichi Sankyo Europe, (hereafter, Daiichi Sankyo) today announced one-year results of four sub-analyses from the European and global ETNA-AF (Edoxaban Treatment in routiNe clinical prActice in patients with nonvalvular Atrial Fibrillation) programme, a non-interventional safety study evaluating edoxaban treatment in routine clinical practice in >26,000 patients around the world with atrial fibrillation (AF).[1],[2],[3],[4] New 12-month data from the European and global ETNA-AF registries showed rates of bleeding and intracranial haemorrhage (ICH) were considered low by the authors' assessment in frail and ageing patients in routine clinical care.[1],[2],[3] Findings, which are part of the largest prospective, non-interventional study programme investigating a single direct oral anticoagulant (DOAC) in patients with non-valvular atrial fibrillation (NVAF) to date, are available virtually at ESC Congress 2020, the annual meeting of the European Society of Cardiology, taking place 29 August – 01 September.

In vulnerable populations such as the ageing, frail and those with renal impairment, anticoagulation for stroke prevention is often not prescribed due to the risk of bleeding, despite these patients being among those most at risk for ischaemic events like stroke.[5] However, outcomes from ETNA-AF reinforce the effectiveness and safety of edoxaban in these populations.[1],[2]

"Ageing and frail patients have been underrepresented in certain AF stroke prevention trials, leaving a lack of evidence to support routine DOAC use in these patients. However, these new data should provide clinicians with some confidence of edoxaban's efficacy and safety profile to reduce the risk of stroke for the ageing and frail AF populations," Dr Ameet Bakhai, Consultant Cardiologist & Cardiovascular R&D Director Royal Free London NHS Trust, UK.

ETNA-AF-Europe Registry Outcomes: Frailty and renal function

Anticoagulation presents multiple challenges in patients who are frail, as well as those who are frail and have renal impairment.[5] The first of the two data analyses from the 13,092 patient-wide ETNA-AF-Europe registry assessed key clinical outcomes and risk scores in frail and ageing patients versus non-frail or younger patients correspondingly.[1] Frailty – commonly defined as those at increased risk of disability, hospitalisation, and mortality[6] – was determined by physician perception.[1] 

Results from 1,392 patients, who were considered frail, showed:[1] 

In addition, the analysis suggested that clinician's perception of frailty appeared to be a better marker of clinical outcomes than age.[1] 

In the second analysis from the ETNA-AF-Europe registry, 13,021 patients with renal impairment were observed to evaluate baseline characteristics and assess follow-up outcomes at one-year.[2] The presence of AF is linked with a greater risk of developing moderate and severe renal impairment, and clinically, anticoagulation presents multiple challenges in patients with impaired renal function because the pharmacokinetic properties and bioavailability of the treatment are often altered in those patients.[7],[8] Findings of this analysis indicated that across the three groups (moderate to severe renal disease [CrCl ≤50 mL/min], mild renal disease [CrCl 50–80 mL/min] and normal renal function [CrCl ≥80 mL/min]), who were categorised according to their creatinine clearance (CrCl) levels, patients treated with edoxaban had low rates of ICH and haemorrhagic stroke, by the investigators' assessment, and these results were similar in patients across all groups studied.[2] Regarding renal function, ICH occurred in 0.18%, 0.32% and 0.17% of patients annually, while haemorrhagic stroke occurred in 0.04%, 0.17% and 0.10% of patients in the group with moderate to severe renal disease, mild renal disease and normal renal function, respectively.[2]

Global ETNA-AF: Treatment of ageing patients

Findings from one of two global sub-analyses showed that at 12 months, rates of ICH were consistently low across all age groups, while CV mortality increased numerically with age, but to a lower extent than all-cause mortality.[3] Additional findings from the global registry, assessing the safety and effectiveness of edoxaban given at the recommended or non-recommended dose in AF patients during one-year observation in routine clinical practice, showed that edoxaban is being prescribed at the label recommended dose in the vast majority of patients, but that non-recommended edoxaban dosage tends to occur more frequently when the CrCl or body weight was closer to the threshold of dose reduction.[4]

"AF is common in the ageing population as are comorbidities and higher rates of CV events, including bleeding, which all need to be managed with a great deal of consideration for the challenges they present for both clinicians and patients," said Wolfgang Zierhut MD, Executive Director Medical Affairs and Head Thrombosis and Cardiovascular at Daiichi Sankyo Europe. "These latest data show the consistency of edoxaban treatment in providing benefits to a wide range of patients."

ETNA-AF is one of more than 10 randomised, controlled trials (RCTs), registries and non-randomised clinical studies that comprise the Edoxaban Clinical Research Programme.

All of the ETNA-AF non-interventional study data presented at ESC Congress 2020 can be found here.

Additional edoxaban data presented

In addition to ETNA-AF, data from multiple clinical studies from the Edoxaban Clinical Research Programme were also presented.



Serial measurement of biomarkers and the risk of stroke or systemic embolism and bleeding in patients with atrial fibrillation in ENGAGE AF-TIMI 48

Oyama et al

Is there a role for half-dose anticoagulation in atrial fibrillation? Randomized comparison of 2 doses of edoxaban in 14,014 patients in ENGAGE AF-TIMI 48

Steffel et al


Edoxaban in atrial fibrillation with PCI by ACS or stable CAD presentation: a pre-specified analysis of the ENTRUST-AF PCI trial

Vranckx et al


Risk factors associated with stroke/systemic embolic events in elderly non-valvular atrial fibrillation patients in the ANAFIE registry, the largest real-world elderly AF registry

Inoue et al

Risk factors of major bleeding in elderly atrial fibrillation patients from the ANAFIE registry

Inoue et al

Real-world effectiveness and the safety of anticoagulant treatment in elderly non-valvular atrial fibrillation in the ANAFIE registry, the largest real-world elderly AF registry

Yamashita et al

Gesundheitsforen Leipzig

Comparison of clinical outcomes with edoxaban versus apixaban, dabigatran, rivaroxaban, and vitamin K antagonist in patients with atrial fibrillation in Germany: a real-world cohort study

Marston et al

Improved adherence to anticoagulant therapy with once-daily regimen: a real-world study in patients with atrial fibrillation in Germany

Yeh et al



ETNA-AF (Edoxaban Treatment in routiNe clinical prActice in patients with nonvalvular Atrial Fibrillation) is a global programme that combines data from distinct non-interventional studies in Europe, East Asia, and Japan in a single database. A total of more than 28,000 patients will be included in the ETNA-AF registries and followed for two years (patients in Europe will be followed for four years). The primary objective of ETNA-AF is to collect information on the use of edoxaban in routine clinical practice, including the safety and efficacy profile in non-preselected patients with NVAF.[9],[10],[11],[12],[13]

About AF

AF is a condition where the heart beats irregularly and rapidly. When this happens, blood can pool and thicken in the chambers of the heart causing an increased risk of blood clots. These blood clots can break off and travel through the blood stream to the brain (or sometimes to another part of the body), where they have the potential to cause a stroke.[14]

AF is the most common type of heart rhythm disorder and is associated with substantial morbidity and mortality.[15] More than six million Europeans are diagnosed with AF, and this figure is expected to at least double over the next 50 years.[16],[17] Compared to those without AF, people with the arrhythmia have a 3-5 times higher risk of stroke.[18] One in five of all strokes are as a result of AF.[16]

About Edoxaban

Edoxaban is an oral, once-daily, direct factor Xa (pronounced "Ten A") inhibitor. Factor Xa is one of the key components responsible for blood clotting, so inhibiting this makes the blood thin and less prone to clotting. Edoxaban is currently marketed by Daiichi Sankyo and its partners in more than 30 countries and regions around the world.

More information on the edoxaban clinical trials can be found on:

Media Contacts

Dr. Wolfgang Schiessl
Daiichi Sankyo Europe GmbH 
Director Product PR and Communications
Cardiovascular Europe
+49 151 1714 7317

Alistair Gordon
Daiichi Sankyo UK Ltd.
Government Affairs and Corporate Communications Manager 
+44 7591 953 681

About Daiichi Sankyo

Daiichi Sankyo Group is dedicated to the creation and supply of innovative pharmaceutical therapies to improve standards of care and address diversified, unmet medical needs of people globally by leveraging our world-class science and technology. With more than 100 years of scientific expertise and a presence in more than 20 countries, Daiichi Sankyo and its 15,000 employees around the world draw upon a rich legacy of innovation and a robust pipeline of promising new medicines to help people. In addition to a strong portfolio of medicines for cardiovascular diseases, under the Group's 2025 Vision to become a "Global Pharma Innovator with Competitive Advantage in Oncology," Daiichi Sankyo is primarily focused on providing novel therapies in oncology, as well as other research areas centered around rare diseases and immune disorders. For more information, please visit:   

Forward-looking statements

This press release contains forward-looking statements and information about future developments in the sector, and the legal and business conditions of DAIICHI SANKYO Co., Ltd. Such forward-looking statements are uncertain and are subject at all times to the risks of change, particularly to the usual risks faced by a global pharmaceutical company, including the impact of the prices for products and raw materials, medication safety, changes in exchange rates, government regulations, employee relations, taxes, political instability and terrorism as well as the results of independent demands and governmental inquiries that affect the affairs of the company. All forward-looking statements contained in this release hold true as of the date of publication. They do not represent any guarantee of future performance. Actual events and developments could differ materially from the forward-looking statements that are explicitly expressed or implied in these statements. DAIICHI SANKYO Co., Ltd. assume no responsibility for the updating of such forward-looking statements about future developments of the sector, legal and business conditions and the company.


  1. Bakhai A, et al. Still on 'aspirin or nothing' for AF patients with frailty? ETNA-AF-Europe shows frailty corresponds to higher mortality but not neurological bleeding with edoxaban anticoagulation in routine care. Poster presented at ESC Congress 2020.
  2. de Caterina R, et al. Baseline characteristics and follow-up outcomes in routine clinical practice patients categorised by renal function in the ETNA-AF-Europe registry. Poster presented at ESC Congress 2020.
  3. Yamashita T, et al. Edoxaban Treatment of Elderly Patients with Atrial Fibrillation in Routine Clinical Practice: 1-Year Results of the Non-interventional Global ETNA-AF Program. Rapid Fire Abstract presented at ESC Congress 2020.
  4. Chao T-F, et al. Recommended and non-recommended edoxaban dosing in patients with atrial fibrillation: one-year clinical events from the Global ETNA-AF non-interventional study. Rapid Fire Abstract presented at ESC Congress 2020.
  5. Seelig J, et al. When to withhold oral anticoagulation in atrial fibrillation – an overview of frequent clinical discussion topics. Vasc Health Risk Manag. 2019;15:399–408.
  6. Pritchard, J.M., et al. Measuring frailty in clinical practice: a comparison of physical frailty assessment methods in a geriatric out-patient clinic. BMC Geriatr 17, 264 (2017). 
  7. Soliman, et al. Chronic Kidney Disease and Prevalent Atrial Fibrillation: The Chronic Renal Insufficiency Cohort (CRIC). Am Heart J. 2010 Jun; 159(6): 1102–1107.
  8. Sciascia, et al. Chronic kidney disease and anticoagulation: from vitamin K antagonists and heparins to direct oral anticoagulant agents. Intern Emerg Med. 2017:12;1101-8.
  9. Edoxaban Treatment in Routine Clinical Practice for Patients With Non Valvular Atrial Fibrillation (ETNA-AF-EU). Available at: Accessed August 2020.
  10. Edoxaban Treatment in Routine Clinical Practice for Patients With Atrial Fibrillation in Korea and Taiwan (ETNA-AF- KOR-TWN). Available at: Accessed August 2020.
  11. Edoxaban Treatment in Routine Clinical Practice for Patients With Non-valvular Atrial Fibrillation (ETNA-AF-Hong Kong). Available at: Accessed August 2020.
  12. Edoxaban Treatment in Routine Clinical Practice for Patients With Non-Valvular Atrial Fibrillation (NVAF). Available at: Accessed August 2020.
  13. ETNA-AF-Japan. Available at: Accessed August 2020.
  14. National Heart, Lung and Blood Institute – What is Atrial Fibrillation. Available at:
  15. Iqbal MB, et al. Recent developments in atrial fibrillation. BMJ. 2005;330(7485):238–43.
  16. Camm AJ, et al. Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Eur Heart J. 2010;31(19):2369-2429.
  17. Krijthe BP, et al. Projections on the number of individuals with atrial fibrillation in the European Union, from+- 2000 to 2060. Eur Heart J. 2013;34(35):2746-2751.
  18. Ball J, et al. Atrial fibrillation: Profile and burden of an evolving epidemic in the 21st century. Int J Card. 2013;167:1807-1824.


Date of preparation: August 2020

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