Does Device-Detected Atrial Fibrillation Lasting <24 Hours Merit Anticoagulation?

A meta-analysis of two large randomized trials suggests that the extra major-bleeding risk outweighs the small reduction in absolute risk for ischemic stroke.

Evidence that episodes of atrial fibrillation (AF) lasting ≥24 hours increase the risk for stroke is reasonably strong, so most clinical guidelines recommend oral anticoagulation therapy for patients with “clinical AF.” For episodes of device-detected AF lasting <24 hours (so-called “subclinical AF”), the data are less clear. To explore the second scenario, investigators systematically reviewed randomized trials comparing anticoagulation with no anticoagulation in patients with device-detected AF <24 hours. For their meta-analysis, they identified only two trials: NOAH-AFNET 6 (edoxaban vs. aspirin or placebo; 2536 patients; NCT02618577) and ARTESiA (apixaban vs. aspirin; 4012 patients; NCT01938248). Average follow-up was 1.8 years and 3.5 …

Reviewing Author

Mark S. Link, MD

Disclosures

Editorial BoardsCirculation; UpToDate

Mark S. Link, MD

Disclosures

Editorial BoardsCirculation; UpToDate

Does Device-Detected Atrial Fibrillation Lasting <24 Hours Merit Anticoagulation?

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Reviewing Author