Lancet Neurol
Do patients with subclinical afib benefit from anticoagulation?
February 26, 2025
Study details: The ARTESiA trial was a double-blind, randomized controlled trial conducted across 247 sites in 16 countries, involving 4,012 adults ≥55 years with device-detected subclinical afib and a CHA2DS2-VASc score of ≥3. Participants were randomly assigned to receive either apixaban 5 mg bid or aspirin 81 mg once daily. This subgroup analysis focused on 346 participants with a history of stroke or TIA.
Results: The annual rate of stroke or systemic embolism was significantly lower in the apixaban group (1.20%) vs. the aspirin group (3.14%), with a hazard ratio of 0.40. However, the risk of major bleeding was higher with apixaban (2.26%) compared with aspirin (1.16%).
Clinical impact: Apixaban offers a substantial benefit in reducing the risk of stroke or systemic embolism in patients with subclinical afib and a history of stroke or TIA. However, the increased bleeding risk necessitates careful consideration in clinical decision-making.
Source:
Shoamanesh A, et al; ARTESiA study investigators. (2025, February). Lancet Neurol. Apixaban versus aspirin for stroke prevention in people with subclinical atrial fibrillation and a history of stroke or transient ischaemic attack: subgroup analysis of the ARTESiA randomised controlled trial. https://pubmed.ncbi.nlm.nih.gov/39862882/
TRENDING THIS WEEK
