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The Lead Episode 175: A Discussion of Anticoagulation for AF with Intermediate Stroke Risk
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In this episode of The Lead, recorded live at HRX 2026, host Melissa E. Middeldorp, MPH, PhD, FHRS, is joined by James Freeman, MD, MPH, MSci, and Rachel Schreier, MSN, ACNP, APRN, to discuss the recently published New England Journal of Medicine article “Anticoagulation for Atrial Fibrillation with Intermediate Stroke Risk.” The panel examines the findings of the SINGLE-AF trial, including the potential benefits of direct oral anticoagulants (DOACs) in patients with intermediate stroke risk, the study's low event rates and limitations, and the implications for individualized risk assessment, shared decision-making, and clinical practice.

  1. Describe the design, patient population, and primary findings of the SINGLE-AF trial evaluating DOAC therapy in patients with atrial fibrillation and intermediate stroke risk.

  2. Evaluate the limitations of the SINGLE-AF trial, including low event rates, patient demographics, antiplatelet use, and the potential influence of atrial fibrillation burden and prior ablation.

  3. Apply the trial findings to individualized anticoagulation decisions by considering stroke risk factors, bleeding risk, patient preferences, and shared decision-making.


Podcast Contributors

Host: 

Melissa E. Middeldorp, MPH, PhD, FHRS | Adelaide University

 

Guests: 

James Freeman, MD, MPH, MSci | Yale University School of Medicine

Rachel Schreier, MSN, ACNP, APRN | Carilion Clinic

 

All relevant financial relationships have been mitigated.

Host and Contributor Disclosure(s):

M. Middeldorp
  • Nothing to disclose


J. Freeman

  • Honoraria/Speaking/Consulting Fees: Boston Scientific, Biosense Webster, Inc. 
  • Membership on Advisory Committee: Medtronic, Pacemate
  • Research (Contracted Grants): American College of Cardiology, National Institutes for Health


R. Schreier

  • Nothing to disclose



Staff Disclosure(s) (note: HRS staff are NOT in control of educational content. Disclosures are provided solely for full transparency to the learner):

S. Sailor: No relevant financial relationships with ineligible companies to disclose.
M. Baldwin: No relevant financial relationships with ineligible companies to disclose.