The Lead Episode 73: A Discussion of Time to Benefit and Harm of Direct Oral Anticoagulants in Device-Detected Atrial Fibrillation-Heart Rhythm Journal (Visual Aid)

Heart Rhythm Journal (Visual Aid)

Pdf Summary

In a pooled analysis of the NOAH-AFNET 6 and ARTESiA trials, researchers examined the benefits and risks of direct oral anticoagulants (DOACs) in elderly patients with device-detected atrial fibrillation (DD-AFib). The study found that while DOACs reduced the risk of stroke, they also increased the risk of major bleeding. It was observed that 2.67 years were needed to prevent one stroke per 100 DOACs-treated patients, whereas 1.67 years were needed to observe one major bleeding event per 100 patients treated with DOACs. This suggests a delayed stroke-preventive benefit and an early-onset bleeding risk associated with DOACs in this patient population. Comparisons were made between DD-AFib and clinical AFib patients, revealing differences in the time needed to derive benefits from oral anticoagulation therapy due to varying arrhythmia burdens. The study emphasizes the importance of shared decision-making discussions between clinicians and patients regarding the risks and benefits of DOACs. Limitations of the study included an emphasis on shorter DD-AFib durations and the absence of factors such as stroke and bleeding severity in TTB and TTH calculations. The findings offer insights into the risk-benefit profiles of DOACs in elderly DD-AFib patients and underscore the need for individualized decision-making in clinical practice.

Keywords

DOACs

elderly patients

device-detected atrial fibrillation

stroke prevention

major bleeding risk

shared decision-making

arrhythmia burdens

oral anticoagulation therapy

risk-benefit profiles

individualized decision-making