ARTESiA

Apixaban for the Reduction of Thrombo-Embolism in Patients With Device-Detected Subclinical Atrial Fibrillation

Paziente / Popolazione Intervento / Esposizione Confronto Esito

In 4,012 patients with device-detected subclinical AF and stroke risk factors, apixaban reduced stroke or systemic embolism compared with aspirin, at the cost of more bleeding.

4012

Disegno

Double-blind, double-dummy RCT

Esito

Stroke or systemic embolism

Rilevanza

Risultato0.78%/patient-yr vs 1.24%/patient-yr (HR 0.63, 95% CI 0.45-0.88; P=0.007). Major bleeding increased with apixaban (HR 1.80, 95% CI 1.26-2.57).

Healey JS, et al. N Engl J Med. 2024;390(2):107-117. 10.1056/NEJMoa2310234

Discussione e critica

Absolute stroke reduction was small (~0.4%/yr) and offset by increased major bleeding, so anticoagulation for subclinical AF demands individualised risk-benefit weighing. With NOAH-AFNET 6 tempered enthusiasm for routine anticoagulation of brief device-detected AF.