![]() ![]() Disclosures for the coauthors are listed in the paper. Link has no relevant financial relationships. ![]() "Unanswered questions are currently explored in two large-scale prospective trials," Apixaban for the Reduction of Thrombo-Embolism in Patients With Device-Detected Sub-Clinical Atrial Fibrillation (ARTESIA) and Non-Vitamin K Antagonist Oral Anticoagulants in Patients With Atrial High Rate Episodes (NOAH), Hohnloser and Vamos note.ĭaiichi-Sankyo Pharma funded the ENGAGE AF-TIMI 48 trial. Ongoing research should provide more clues. "That's a very relevant clinical question, because if you have an increased risk of stroke you should be anticoagulated," he said. Various studies have suggested that stroke risk begins when AF episodes last 5 minutes, 24 hours, or 40 seconds, so the question is when do short AF episodes start increasing the risk of stroke. Subclinical AF is the next frontier in this line of research, Link remarked. For risk of outcome with paroxysmal AF vs permanent AF, after multivariable adjustment Outcomes for Patients with Paroxysmal, Persistent, or Permanent AF at Baseline Outcomeī. Patients with paroxysmal AF had a significantly lower risk of thromboembolism and a similar risk of major bleeding as other patients. There were more than 650 stroke and SEE events. Link and colleagues examined data from the 21,105 subjects in the ENGAGE AF-TIMI 48 trial, which comprised 5366 patients (25%) with paroxysmal AF (episodes 2. In contrast, in the RE-LY trial, the risk of stroke/SEE was 1.32%/year in patients with paroxysmal AF, which was not statistically significantly lower than the rates of 1.55%/year and 1.49%/year among patients with persistent AF and permanent AF, respectively. Most recent NOAC trials-such as the SPORTIF, ARISTOTLE, ROCKET-AF, and AVERROES trials-have reported that patients with paroxysmal AF had a lower risk of stroke/SEE than patients with persistent AF. The CHA 2DS 2-VASc score for estimating stroke risk in patients with AF does not consider the pattern of AF, and prior studies have reported conflicting results for this risk in patients with different types of AF, Link and colleagues write. On the other hand, "patients with a CHA 2DS 2-VASc score of 3 or more should receive anticoagulation therapy no matter what type of AF they have."ĪF Patterns and Stroke Risk, Conflicting Results For example, if a patient has a CHA 2DS 2-VASc score of 1 or 2 and has persistent AF, "I'd be more inclined to offer them anticoagulation than if they had paroxysmal AF," he said. "When you are sitting with a patient and discussing anticoagulation, the frequency of AF can now play a part in that decision," Link said. While two studies that should shed light on the shortest duration of AF that warrants anticoagulation therapy are still ongoing, this and other studies still suggest that "subjects with clinically documented paroxysmal AF should receive anticoagulation treatment, preferably with a NOAC, similar to subjects with persistent or permanent AF," they conclude. It showed that paroxysmal AF was associated with a lower risk of stroke and all-cause mortality, and edoxaban had the same efficacy and safety in patients with different types of AF. Engage af timi 48 trial#This was the largest novel oral anticoagulant (NOAC) trial with the longest follow-up and hundreds of outcomes and provides important information, Drs Stefan H Hohnloser and Mate Vamos (JW Goethe University, Frankfurt, Germany) write in an accompanying editorial. The study also showed that the benefits of edoxaban vs warfarin were preserved even for paroxysmal AF, "so it still dropped the risk of stroke relative to warfarin," he added. ![]()
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