Arrhythmias & electrophysiologyMeta-analysis
Anticoagulation in device-detected atrial fibrillation with or without vascular disease: a combined analysis of the NOAH-AFNET 6 and ARTESiA trials
- Combined analysis of the NOAH-AFNET 6 and ARTESiA randomised trials
- pre-specified
- subgroup analysis by vascular disease
- meta-analysis of 2 trials
Authors' conclusion
Patients with DDAF and vascular disease are at higher risk of stroke and cardiovascular events and may derive a greater benefit from anticoagulation than patients with DDAF without vascular disease.
Study context
- Population
- Patients with device-detected AF (device-detected atrial fibrillation (DDAF)), with or without vascular disease (prior stroke/TIA, coronary or peripheral artery disease)2 RCTs
- Comparison
- Anticoagulation vs no anticoagulation, with or without vascular disease
- Outcome
- Composite of:
- Stroke
- Systemic arterial embolism
- MI
- PE
- CV death (primary outcomes of both trials)
Pooled result
As reported in the abstract
Stroke, MI, systemic or PE, or CV death, by vascular disease
- Vascular disease, NOAH-AFNET 6: anticoagulation vs no anticoagulation
- 3.9%/patient-year vs 5.0%/patient-year
- Vascular disease, ARTESiA: anticoagulation vs no anticoagulation
- 3.2%/patient-year vs 4.4%/patient-year
- No vascular disease, NOAH-AFNET 6: equal in both randomized groups
- 2.7%/patient-year
- No vascular disease, ARTESiA: equal in both randomized groups
- 2.3%/patient-year
- Heterogeneity across trials
- I2heterogeneity = 6%
Further pooled results
Stroke/SE
- Behaved similarly
Safety
| Outcome | Values | IRR (CI) | |
|---|---|---|---|
| Major bleeding, vascular disease | Edoxaban 2.1%/patient-year · No anticoagulation (NOAH-AFNET 6) 1.3%/patient-year · Apixaban 1.7%/patient-years · No anticoagulation (ARTESiA) 1.1%/patient-year | 1.55 (1.10–2.20) | |
| Major bleeding, no vascular disease | Edoxaban 2.2%/patient-year · No anticoagulation (NOAH-AFNET 6) 0.6%/patient-year · Apixaban 1.4%/patient-year · No anticoagulation (ARTESiA) 1.1%/patient-year | 1.93 (0.72–5.20) | |
| 0.20.5125Incidence rate ratio (log scale) |
Original publication
Anticoagulation in device-detected atrial fibrillation with or without vascular disease: a combined analysis of the NOAH-AFNET 6 and ARTESiA trials. Eur Heart J. Published 2 September 2024. doi:10.1093/eurheartj/ehae596
Summarised from the published abstract; every number is checked against it