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Subgroup Analysis Insights: Apixaban vs. aspirin in subclinical atrial fibrillation based on CHA2DS2-VASc score – J Am Coll Cardiol

27 May, 2024 | 20:21h | UTC

Study Design and Population: This study is a subgroup analysis of the ARTESiA trial, which compared the efficacy and safety of apixaban versus aspirin in preventing stroke and systemic embolism (SE) in patients with subclinical atrial fibrillation (SCAF). The analysis focused on 4,012 patients categorized by their baseline CHA2DS2-VASc scores: <4 (39.4%), 4 (33.6%), and >4 (27.0%).

Main Findings: For patients with a CHA2DS2-VASc score >4, apixaban significantly reduced the stroke/SE rate to 0.98%/year compared to 2.25%/year with aspirin, preventing 1.28 strokes/SE per 100 patient-years while causing 0.68 major bleeds. In patients with scores <4, the stroke/SE prevention was minimal (0.12 strokes/SE per 100 patient-years) with a similar rate of major bleeds. Patients with a score of 4 had intermediate results, with a moderate reduction in stroke/SE (0.32 per 100 patient-years) and a comparable risk of major bleeding.

Implications for Practice: The study suggests that for patients with SCAF and a CHA2DS2-VASc score >4, the benefits of apixaban in preventing stroke/SE outweigh the risks of major bleeding. For those with scores <4, aspirin might be a safer option. Patients with a score of 4 fall into an intermediate category, where individual patient preferences should guide the treatment decision.

 

Reference (link to abstract – $ for full-text):

Lopes, R. D., Granger, C. B., Wojdyla, D. M., et al. (2024). Apixaban versus Aspirin According to CHA2DS2-VASc Score in Subclinical Atrial Fibrillation: Insights from ARTESiA. Journal of the American College of Cardiology. Epublished. DOI: 10.1016/j.jacc.2024.05.002.

 


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