AI Article Synopsis
- The ARTESiA study found that apixaban significantly lowers the risk of stroke and systemic embolism compared to aspirin in patients with subclinical atrial fibrillation, but it also increases the risk of major bleeding.
- Researchers analyzed the effectiveness and safety of apixaban based on patients' CHADS-VASc scores, which assess their risk of stroke, revealing that higher scores correlate with greater benefits from apixaban.
- For patients with CHADS-VASc scores over 4, the advantages of taking apixaban for stroke prevention outweigh the bleeding risks, while those with scores below 4 may not benefit as much, emphasizing the need for patient-centered treatment decisions.
Article Abstract
Background: ARTESiA (Apixaban for the Reduction of Thrombo-Embolism in Patients With Device-Detected Sub-Clinical Atrial Fibrillation) demonstrated that apixaban, compared with aspirin, significantly reduced stroke and systemic embolism (SE) but increased major bleeding in patients with subclinical atrial fibrillation.
Objectives: To help inform decision making, the authors evaluated the efficacy and safety of apixaban according to baseline CHADS-VASc score.
Methods: We performed a subgroup analysis according to baseline CHADS-VASc score and assessed both the relative and absolute differences in stroke/SE and major bleeding.
Results: Baseline CHADS-VASc scores were <4 in 1,578 (39.4%) patients, 4 in 1,349 (33.6%), and >4 in 1,085 (27.0%). For patients with CHADS-VASc >4, the rate of stroke was 0.98%/year with apixaban and 2.25%/year with aspirin; compared with aspirin, apixaban prevented 1.28 (95% CI: 0.43-2.12) strokes/SE per 100 patient-years and caused 0.68 (95% CI: -0.23 to 1.57) major bleeds. For CHADS-VASc <4, the stroke/SE rate was 0.85%/year with apixaban and 0.97%/year with aspirin. Apixaban prevented 0.12 (95% CI: -0.38 to 0.62) strokes/SE per 100 patient-years and caused 0.33 (95% CI: -0.27 to 0.92) major bleeds. For patients with CHADS-VASc =4, apixaban prevented 0.32 (95% CI: -0.16 to 0.79) strokes/SE per 100 patient-years and caused 0.28 (95% CI: -0.30 to 0.86) major bleeds.
Conclusions: One in 4 patients in ARTESiA with subclinical atrial fibrillation had a CHADS-VASc score >4 and a stroke/SE risk of 2.2% per year. For these patients, the benefits of treatment with apixaban in preventing stroke/SE are greater than the risks. The opposite is true for patients with CHADS-VASc score <4. A substantial intermediate group (CHADS-VASc =4) exists in which patient preferences will inform treatment decisions. (Apixaban for the Reduction of Thrombo-Embolism in Patients With Device-Detected Sub-Clinical Atrial Fibrillation; NCT01938248).
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Source |
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| http://dx.doi.org/10.1016/j.jacc.2024.05.002 | DOI Listing |
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