Silent AF: Can We Identify Patients Who Benefit from Anticoagulation?

A subgroup analysis from the ARTESiA trial suggests that the CHA₂DS₂-VASc score can help with risk stratification.

Several recent trials examine the benefits and risks of anticoagulation for atrial high-rate episodes (also known as silent atrial fibrillation [AF]; NEJM JW Cardiol Aug 30 2023 and N Engl J Med 2023; 389:1167; NEJM JW Cardiol Nov 13 2023 and N Engl J Med 2024; 390:107). Anticoagulation appears to prevent ischemic events, but these events are infrequent and largely offset by bleeding risk, resulting in limited net gain for patients.

To identify subgroups who may benefit from anticoagulation, researchers analyzed data from the double-blind ARTESiA trial involving 4012 patients with silent AF who were randomized to apixaban (5 mg twice daily) versus aspirin (81 mg once daily). Results were stratified by the CHA₂DS₂-VASc score.

Among those with …

Reviewing Author

Behnood Bikdeli, MD, MS

Disclosures

Grant/Research SupportBrigham and Women’s Hospital; American Heart Association and VIVA Physicians

Editorial BoardsThrombosis Research; Thrombosis and Haemostasis; Journal of the American College of Cardiology

Leadership Positions in Professional SocietiesSociety for Vascular Medicine (Research, Quality, and Publications Committee member); International Society on Thrombosis and Haemostasis

Behnood Bikdeli, MD, MS

Disclosures

Grant/Research SupportBrigham and Women’s Hospital; American Heart Association and VIVA Physicians

Editorial BoardsThrombosis Research; Thrombosis and Haemostasis; Journal of the American College of Cardiology

Leadership Positions in Professional SocietiesSociety for Vascular Medicine (Research, Quality, and Publications Committee member); International Society on Thrombosis and Haemostasis

Silent AF: Can We Identify Patients Who Benefit from Anticoagulation?

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Reviewing Author