The Lead Episode 175: A Discussion of Anticoagulation for AF with Intermediate Stroke Risk-The Lead Episode 175 Video File

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Video Summary

The SINGLE-AF trial randomized about 1,800 Korean patients with intermediate stroke risk (CHA₂DS₂-VASc 1 in men or 2 in women) to a direct oral anticoagulant (DOAC) or no anticoagulation for two years. The primary composite outcome occurred in 4 DOAC-treated patients versus 13 controls, largely because strokes were less frequent (3 versus 10). Major bleeding did not differ significantly, though overall event rates were low. About 30% of control patients received antiplatelet therapy.<br /><br />The speakers noted limits to generalizability: participants were relatively healthy, had lower average BMI, and few were women; many had undergone ablation, and AF burden was not well characterized. They viewed the results as supporting anticoagulation for some intermediate-risk patients, while emphasizing individualized risk assessment, patient preferences, and shared decision-making. Further studies in more diverse populations are needed.

Keywords

SINGLE-AF trial

direct oral anticoagulant

intermediate stroke risk

atrial fibrillation

shared decision-making