Apixaban vs. Aspirin for Subclinical Atrial Fibrillation

Brief, device-detected episodes of subclinical atrial fibrillation (AF) during continuous long-term rhythm monitoring are associated with excess risk for ischemic stroke or systemic embolism. To explore whether patients with subclinical AF benefit from routine oral anticoagulant therapy, the ARTESiA investigators randomized 4012 participants to apixaban (5 mg twice daily) or aspirin (81 mg daily).

Although ARTESiA (NCT01938248) was stopped prematurely for slow recruitment, a lower-than-expected event rate, and inability to resupply trial medications, it still identified a significant reduction in the primary outcome of stroke or systemic embolism with apixaban versus aspirin (0.78% vs. 1.24% per patient-year; hazard ratio, 0.63) and in the r…