ESC 2023 — Prof Paulus Kirchhof (University Heart & Vascular Center Hamburg, DE) discusses the findings of the NOAH-AFNET 6 trial (NCT02618577).

NOAH-AFNET 6 (Atrial Fibrillation Network, Daiichi Sankyo Europe) was an investigator-initiated, prospective, randomised trial aiming to demonstrate that oral anticoagulation using the NOAC edoxaban is superior to current therapy in stroke prevention, systemic embolism and cardiovascular death in patients with atrial high rate episodes and stroke risk factors. 2608 patients were enrolled in the trial, which compared edoxaban to ASA or placebo.

The NOAH-AFNET 6 trial revealed that using oral anticoagulation in AHRE patients raises bleeding risk without reducing the combined outcome of stroke, systemic embolism, or cardiovascular death. 
Expectedly, anticoagulation led to more bleeding. Surprisingly, both anticoagulated and non-anticoagulated groups showed low stroke rates. This underscores the need for ECG evidence of atrial fibrillation before starting anticoagulation.

Questions:

1. What is the importance of NOAH-AFNET 6?
2. What was the study design and the eligibility criteria?
3. What are the key findings?
4. What are the take-home messages for practice?
5. How should these findings influence guidelines?

Recorded on-site at ESC Congress 2023, Amsterdam. 

Editors: Mirjam Boros and Jordan Rance
Video Specialists: Dan Brent, Tom Green, Mike Knight, Oliver Miles