Key result
Anticoagulation shows greater potential CV benefit in device-detected AF with vascular disease.
Why the study?
The optimal antithrombotic therapy in patients with device-detected atrial fibrillation with or without vascular disease is unknown.
Does anticoagulation reduce cardiovascular events in patients with device-detected atrial fibrillation with or without vascular disease?
Meta-Analysis (n=6,546)
Randomized
Yes
Does anticoagulation reduce cardiovascular events in patients with device-detected atrial fibrillation with or without vascular disease?
Patients with device-detected atrial fibrillation and concomitant vascular disease may derive a greater benefit from anticoagulation compared to those without vascular disease, despite a similar relative increase in major bleeding.
Answers are grounded in this paper and cite their sources.
Anticoagulation may reduce events more in DDAF with vascular disease than without; extends risk stratification for shared decisions in device-detected AF.
BACKGROUND AND AIMS: The optimal antithrombotic therapy in patients with device-detected atrial fibrillation (DDAF) is unknown. Concomitant vascular disease can modify the benefits and risks of anticoagulation. METHODS: These pre-specified analyses of the NOAH-AFNET 6 (n = 2534 patients) and ARTESiA (n = 4012 patients) trials compared anticoagulation with no anticoagulation in patients with DDAF with or without vascular disease, defined as prior stroke/transient ischaemic attack, coronary or peripheral artery disease. Efficacy outcomes were the primary outcomes of both trials, a composite of stroke, systemic arterial embolism (SE), myocardial infarction, pulmonary embolism or cardiovascular death, and stroke or SE. Safety outcomes were major bleeding or major bleeding and death. RESULTS: In patients with vascular disease (NOAH-AFNET 6, 56%; ARTESiA, 46%), stroke, myocardial infarction, systemic or pulmonary embolism, or cardiovascular death occurred at 3.9%/patient-year with and 5.0%/patient-year without anticoagulation (NOAH-AFNET 6), and 3.2%/patient-year with and 4.4%/patient-year without anticoagulation (ARTESiA). Without vascular disease, outcomes were equal with and without anticoagulation (NOAH-AFNET 6, 2.7%/patient-year; ARTESiA, 2.3%/patient-year in both randomized groups). Meta-analysis found consistent results across both trials (I2heterogeneity = 6%) with a trend for interaction with randomized therapy (pinteraction = .08). Stroke/SE behaved similarly. Anticoagulation equally increased major bleeding in vascular disease patients [edoxaban, 2.1%/patient-year; no anticoagulation, 1.3%/patient-year; apixaban, 1.7%/patient-years; no anticoagulation, 1.1%/patient-year; incidence rate ratio 1.55 (1.10-2.20)] and without vascular disease [edoxaban, 2.2%/patient-year; no anticoagulation, 0.6%/patient-year; apixaban, 1.4%/patient-year; no anticoagulation, 1.1%/patient-year; incidence rate ratio 1.93 (0.72-5.20)]. CONCLUSIONS: Patients with DDAF and vascular disease are at higher risk of stroke and cardiovascular events and may derive a greater benefit from anticoagulation than patients with DDAF without vascular disease.
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Schnabel et al. (2024) conducted a meta-analysis in Device-detected atrial fibrillation (n=6,546). Anticoagulation vs. No anticoagulation was evaluated on Composite of stroke, systemic arterial embolism, myocardial infarction, pulmonary embolism or cardiovascular death (p=0.08). Anticoagulation in patients with device-detected atrial fibrillation showed a trend toward greater cardiovascular benefit in those with vascular disease compared to those without.
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