Anticoagulation in Patients with Transient Subclinical Atrial Fibrillation

In the international ARTESiA trial, 4000 patients with CHA2DS2-VASc scores ≥3 and episodes of subclinical atrial fibrillation (AF; detected by implanted pacemaker, defibrillator, or cardiac monitor, and lasting ≥6 minutes but <24 hours) were randomized to apixaban or aspirin. Apixaban recipients had fewer strokes and more major bleeding events than did aspirin recipients, but the absolute difference for both outcomes was <1 per 100 patient-years. With these low event rates, there was no decisive advantage for anticoagulation (NEJM JW Gen Med Dec 15 2023 and N Engl J Med 2024; 390:107).

Now, in a secondary analysis, the researchers have examined outcomes in an important subgroup — the 9% of participants who had previous strokes or transient i…