Apixaban Benefit in Subclinical Atrial Fibrillation Accounting for Competing Risks: A Reanalysis of the ARTESIA Trial

In the ARTESIA trial, apixaban reduced stroke and systemic embolism compared with aspirin in patients with subclinical atrial fibrillation (AF), but the primary analysis treated death and AF progression as censoring rather than competing events. We estimated the absolute risk reduction (ARR) at 3.5 years treating death and AF progression as competing events. We used event-level data reconstructed from published Kaplan-Meier curves to probabilistically impute status and timing of competing events. The ARR was 1.94% when treating death and AF progression as censoring events vs. 1.62% treating them as competing events (difference 0.33 percentage points; 95% CI 0.04 to 0.62). Absolute benefit estimates depend on how competing events are handled. Competing risk analyses can provide more realistic estimates of expected therapeutic benefit at the point of treatment decisions when competing events are common.