The Lead Episode 38: A Discussion of Apixaban for Stroke Prevention in Subclinical Atrial Fibrillation-The New England Journal of Medicine

The New England Journal of Medicine

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The ARTESIA trial, published in The New England Journal of Medicine, examined the use of apixaban compared to aspirin in preventing strokes in patients with subclinical atrial fibrillation. Subclinical atrial fibrillation is a form of atrial fibrillation that is short-lasting and asymptomatic and is typically only detected through long-term continuous monitoring with devices such as pacemakers or defibrillators. The trial involved 4,012 patients who were randomly assigned to receive either apixaban at a dose of 5 mg twice daily (2.5 mg twice daily when indicated) or aspirin at a dose of 81 mg daily. The study found that apixaban resulted in a lower risk of stroke or systemic embolism compared to aspirin, but it was associated with a higher risk of major bleeding. The primary efficacy outcome, stroke or systemic embolism, occurred in 0.78% of patients per year in the apixaban group compared to 1.24% per year in the aspirin group. The primary safety outcome, major bleeding, occurred in 1.71% of patients per year in the apixaban group compared to 0.94% per year in the aspirin group. The results suggest that apixaban may be effective in preventing strokes in patients with subclinical atrial fibrillation, but the increased risk of major bleeding should be considered when deciding on treatment options. The trial was funded by multiple organizations including the Canadian Institutes of Health Research and the Bristol-Myers Squibb-Pfizer Alliance.

Keywords

ARTESIA trial

apixaban

aspirin

strokes

subclinical atrial fibrillation

long-term continuous monitoring

pacemakers

defibrillators

systemic embolism

major bleeding