Anticoagulation in Patients With Device-Detected Atrial Fibrillation With and Without a Prior Stroke or Transient Ischemic Attack: The NOAH-AFNET 6 Trial
Standard
Anticoagulation in Patients With Device-Detected Atrial Fibrillation With and Without a Prior Stroke or Transient Ischemic Attack: The NOAH-AFNET 6 Trial. / Diener, Hans Christoph; Becher, Nina; Sehner, Susanne; Toennis, Tobias; Bertaglia, Emanuele; Blomstrom-Lundqvist, Carina; Brandes, Axel; Beuger, Vincent; Calvert, Melanie; Camm, A John; Chlouverakis, Gregory; Dan, Gheorghe-Andrei; Dichtl, Wolfgang; Fierenz, Alexander; Goette, Andreas; de Groot, Joris R; Hermans, Astrid; Lip, Gregory Y H; Lubinski, Andrzej; Marijon, Eloi; Merkely, Béla; Mont, Lluís; Nikorowitsch, Julius; Ozga, Ann-Kathrin; Rajappan, Kim; Sarkozy, Andrea; Scherr, Daniel; Schnabel, Renate B; Schotten, Ulrich; Simantirakis, Emmanuel; Vardas, Panos; Wichterle, Dan; Zapf, Antonia; Kirchhof, Paulus; NOAH-AFNET 6 Investigators.
In: J AM HEART ASSOC, Vol. 13, No. 17, e036429, 03.09.2024.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
Harvard
APA
Vancouver
Bibtex
}
RIS
TY - JOUR
T1 - Anticoagulation in Patients With Device-Detected Atrial Fibrillation With and Without a Prior Stroke or Transient Ischemic Attack: The NOAH-AFNET 6 Trial
AU - Diener, Hans Christoph
AU - Becher, Nina
AU - Sehner, Susanne
AU - Toennis, Tobias
AU - Bertaglia, Emanuele
AU - Blomstrom-Lundqvist, Carina
AU - Brandes, Axel
AU - Beuger, Vincent
AU - Calvert, Melanie
AU - Camm, A John
AU - Chlouverakis, Gregory
AU - Dan, Gheorghe-Andrei
AU - Dichtl, Wolfgang
AU - Fierenz, Alexander
AU - Goette, Andreas
AU - de Groot, Joris R
AU - Hermans, Astrid
AU - Lip, Gregory Y H
AU - Lubinski, Andrzej
AU - Marijon, Eloi
AU - Merkely, Béla
AU - Mont, Lluís
AU - Nikorowitsch, Julius
AU - Ozga, Ann-Kathrin
AU - Rajappan, Kim
AU - Sarkozy, Andrea
AU - Scherr, Daniel
AU - Schnabel, Renate B
AU - Schotten, Ulrich
AU - Simantirakis, Emmanuel
AU - Vardas, Panos
AU - Wichterle, Dan
AU - Zapf, Antonia
AU - Kirchhof, Paulus
AU - NOAH-AFNET 6 Investigators
PY - 2024/9/3
Y1 - 2024/9/3
N2 - BACKGROUND: Short and rare episodes of atrial fibrillation (AF) are commonly detected using implanted devices (device-detected AF) in patients with prior stroke or transient ischemic attack (TIA). The effectiveness and safety of oral anticoagulation in patients with prior stroke or TIA and device-detected AF but with no ECG-documented AF is unclear.METHODS AND RESULTS: This prespecified analysis of the NOAH-AFNET 6 (Non-Vitamin K Antagonist Oral Anticoagulants in Patients With Atrial High Rate Episodes) trial with post hoc elements assessed the effect of oral anticoagulation in patients with device-detected AF with and without a prior stroke or TIA in the randomized, double-blind, double-dummy NOAH-AFNET 6 trial. Outcomes were stroke, systemic embolism, and cardiovascular death (primary outcome) and major bleeding and death (safety outcome). A prior stroke or TIA was found in 253 patients with device-detected AF randomized in the NOAH-AFNET 6 (mean age, 78 years; 36.4% women). There was no treatment interaction with prior stroke or TIA for any of the primary and secondary time-to-event outcomes. In patients with a prior stroke or TIA, 14 out of 122 patients experienced a primary outcome event with anticoagulation (5.7% per patient-year). Without anticoagulation, there were 16 out of 131 patients with an event (6.3% per patient-year). The rate of stroke was lower than expected (anticoagulation: 4 out of 122 [1.6% per patient-year]; no anticoagulation: 6 out of 131 [2.3% per patient-year]). Numerically, there were more major bleeding events with anticoagulation in patients with prior stroke or TIA (8 out of 122 patients) than without anticoagulation (2 out of 131 patients).CONCLUSIONS: Anticoagulation appears to have ambiguous effects in patients with device-detected AF and a prior stroke or TIA in this hypothesis-generating analysis of the NOAH-AFNET 6 in the absence of ECG-documented AF, partially due to a low rate of stroke without anticoagulation.
AB - BACKGROUND: Short and rare episodes of atrial fibrillation (AF) are commonly detected using implanted devices (device-detected AF) in patients with prior stroke or transient ischemic attack (TIA). The effectiveness and safety of oral anticoagulation in patients with prior stroke or TIA and device-detected AF but with no ECG-documented AF is unclear.METHODS AND RESULTS: This prespecified analysis of the NOAH-AFNET 6 (Non-Vitamin K Antagonist Oral Anticoagulants in Patients With Atrial High Rate Episodes) trial with post hoc elements assessed the effect of oral anticoagulation in patients with device-detected AF with and without a prior stroke or TIA in the randomized, double-blind, double-dummy NOAH-AFNET 6 trial. Outcomes were stroke, systemic embolism, and cardiovascular death (primary outcome) and major bleeding and death (safety outcome). A prior stroke or TIA was found in 253 patients with device-detected AF randomized in the NOAH-AFNET 6 (mean age, 78 years; 36.4% women). There was no treatment interaction with prior stroke or TIA for any of the primary and secondary time-to-event outcomes. In patients with a prior stroke or TIA, 14 out of 122 patients experienced a primary outcome event with anticoagulation (5.7% per patient-year). Without anticoagulation, there were 16 out of 131 patients with an event (6.3% per patient-year). The rate of stroke was lower than expected (anticoagulation: 4 out of 122 [1.6% per patient-year]; no anticoagulation: 6 out of 131 [2.3% per patient-year]). Numerically, there were more major bleeding events with anticoagulation in patients with prior stroke or TIA (8 out of 122 patients) than without anticoagulation (2 out of 131 patients).CONCLUSIONS: Anticoagulation appears to have ambiguous effects in patients with device-detected AF and a prior stroke or TIA in this hypothesis-generating analysis of the NOAH-AFNET 6 in the absence of ECG-documented AF, partially due to a low rate of stroke without anticoagulation.
U2 - 10.1161/JAHA.124.036429
DO - 10.1161/JAHA.124.036429
M3 - SCORING: Journal article
C2 - 39190564
VL - 13
JO - J AM HEART ASSOC
JF - J AM HEART ASSOC
SN - 2047-9980
IS - 17
M1 - e036429
ER -