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June 27, 2026EP EuropaceOpen Access

Compared with normal renal function, impaired renal function was associated with higher risks of IS/TIA/SEE (HR 1.79, 95% CI 1.09–2.93, P=0.0217), major bleeding (HR 1.71, 95% CI 1.02–2.88, P=0.0429), and all-cause death (HR 3.07, 95% CI 1.97–4.80, P<0.0001).

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Why the study?

Does impaired renal function and other high bleeding risk factors increase the risk of adverse clinical outcomes in Asian patients with atrial fibrillation treated with edoxaban?

Population

3,299 patients with atrial fibrillation from South Korea, Taiwan, Thailand, and Hong Kong receiving edoxaban…

Comparison

Impaired renal function and presence of… vs Normal renal function and absence of additional…

Design

Cohort

Follow-up

2 years

Authors

JCJ I ChoiCWC C WangDPD Piyayotai

Discussion

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Overview

Impaired RF signals excess risk on edoxaban in AF; leaves optimal dosing and interventions unresolved.

Key Points

  • This analysis aims to assess the impact of renal impairment and other bleeding risk factors on clinical outcomes for Asian patients with atrial fibrillation receiving edoxaban.
  • Prospective, observational study from South Korea, Taiwan, Thailand, and Hong Kong
  • Patients with atrial fibrillation receiving edoxaban were included
  • Cox regression models evaluated the association between renal function and clinical outcomes.
  • Impaired renal function was associated with significantly higher risks of ischaemic stroke (HR 1.79, 95% CI 1.09–2.93, P=0.0217) and major bleeding (HR 1.71, 95% CI 1.02–2.88, P=0.0429).
  • Patients with low CrCl (<30 mL/min) showed markedly increased risks for major gastrointestinal bleeding (HR 5.62, 95% CI 2.22–14.24, P=0.0003) and all-cause death (HR 3.96, 95% CI 2.47–6.34, P<0.0001).
  • Underweight patients faced higher risks of all-cause death (HR 2.42, 95% CI 1.08–5.41, P=0.0312) compared to normal weight.

Structured PICO

Does impaired renal function and other high bleeding risk factors increase the risk of adverse clinical outcomes in Asian patients with atrial fibrillation treated with edoxaban?

P
Population
3,299 patients with atrial fibrillation from South Korea, Taiwan, Thailand, and Hong Kong receiving edoxaban at baseline.
I
Intervention
Impaired renal function (CrCl <60 mL/min) and presence of additional bleeding risk factors (high DOAC score, BMI ≤18.5 kg/m², CrCl <30 mL/min) while on edoxaban.
C
Comparator
Normal renal function (CrCl ≥60 mL/min) and absence of additional bleeding risk factors (moderate/low DOAC score, BMI 18.5-23.0 kg/m², CrCl 30-60 mL/min) while on edoxaban.
O
Outcome
Clinical outcomes at 2 years including ischaemic stroke (IS)/transient ischaemic attack (TIA)/systemic embolic event (SEE), major bleeding (MB), major gastrointestinal (GI) bleeding, all-cause death (ACD), and net clinical outcome (NCO).hard clinical

In Asian patients with atrial fibrillation treated with edoxaban, impaired renal function and additional risk factors such as low BMI significantly amplify the risk of both thromboembolic and bleeding events.

Cite This Study

Choi et al. (2026) studied this question.

synapsesocial.com/papers/6a3f97e8125782b61d865aa2https://doi.org/10.1093/europace/euag105.338
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Association of diabetes mellitus status and clinical outcomes of edoxaban in patients with atrial fibrillation: a sub-analysis from the ETNA-AF Asian registry2026
  2. 2Impact of Age on Bleeding, Stroke, and Mortality in Edoxaban-Treated Patients with Atrial Fibrillation: Results from the ETAF-TR Registry2026
  3. 3Impact of weight/BMI on clinical and bleeding events in 26 805 atrial fibrillation patients on edoxaban from the Global ETNA-AF Registry2025
  4. 4Impact of kidney function on cardiovascular outcome in patients with device-detected atrial fibrillation in NOAH-AFNET 62026
  5. 5Predictors for non-persistence to edoxaban in Asian patients with atrial fibrillation: 2-year follow-up data from the ETNA-AF programme2026