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Whether benefits of anticoagulation generally outweigh harms in patients with transient, incidentally discovered atrial fibrillation (AF) is unclear. To address this issue, researchers identified 4000 patients (mean age, 77) with CHA2DS2-VASc scores ≥3 and at least one episode of subclinical AF (detected by an implanted pacemaker, defibrillator, or cardiac monitor) lasting at least 6 minutes but not exceeding 24 hours. Patients were randomized to apixaban or aspirin, and the following outcomes were noted:
During average follow-up of 3.5 years, the incidence of stroke or systemic embolism was significantly lower with apixaban than with aspirin (0.78 vs. 1.24 per 100 patient-years). This translates to 1 fewer stroke per 217 apixaban recipients…