Arrhythmias & electrophysiology
Apixaban vs Aspirin According to CHA2DS2-VASc Score in Subclinical Atrial Fibrillation: Insights From ARTESiA
Authors' conclusion
One in 4 patients in ARTESiA with subclinical atrial fibrillation had a CHA2DS2-VASc score >4 and a stroke/SE risk of 2.2% per year. For these patients, the benefits of treatment with apixaban in preventing stroke/SE are greater than the risks. The opposite is true for patients with CHA2DS2-VASc score <4.
Study context
- Population
- Patients with subclinical (device-detected) AF in ARTESiA, by baseline CHA2DS2-VASc score (<4: 1,578 [39.4%]; 4: 1,349 [33.6%]; >4: 1,085 [27.0%])
- Comparison
- Apixaban vs aspirin
- Primary endpoint
- Relative and absolute differences in stroke/SE and major bleeding by baseline CHA2DS2-VASc score
Methodological detailssubgroup analysis by baseline CHA2DS2-VASc score
- Subgroup analysis by baseline CHA2DS2-VASc score
Primary result
As reported in the abstract
Stroke/SE by CHA2DS2-VASc score
Strokes/SE prevented
1.28 per 100 patient-years (95% CI 0.43–2.12)
CHA2DS2-VASc >4
Strokes/SE prevented
0.32 per 100 patient-years (95% CI −0.16 to 0.79)
CHA2DS2-VASc =4
Strokes/SE prevented
0.12 per 100 patient-years (95% CI −0.38 to 0.62)
CHA2DS2-VASc <4
Apixaban
- Stroke, CHA2DS2-VASc >4
- 0.98%/year
- Stroke/SE, CHA2DS2-VASc <4
- 0.85%/year
Aspirin
- Stroke, CHA2DS2-VASc >4
- 2.25%/year
- Stroke/SE, CHA2DS2-VASc <4
- 0.97%/year
Stroke, CHA2DS2-VASc >4
Apixaban0.98%/year
Aspirin2.25%/year
Stroke/SE, CHA2DS2-VASc <4
Apixaban0.85%/year
Aspirin0.97%/year
Safety
| Outcome | Major bleeds caused (per 100 patient-years) (95% CI) |
|---|---|
| Major bleeding by CHA2DS2-VASc scoreApixaban vs Aspirin · CHA2DS2-VASc >4 | 0.68 (−0.23 to 1.57) |
| Major bleeding by CHA2DS2-VASc scoreApixaban vs Aspirin · CHA2DS2-VASc =4 | 0.28 (−0.30 to 0.86) |
| Major bleeding by CHA2DS2-VASc scoreApixaban vs Aspirin · CHA2DS2-VASc <4 | 0.33 (−0.27 to 0.92) |
Original publication
Apixaban vs Aspirin According to CHA2DS2-VASc Score in Subclinical Atrial Fibrillation: Insights From ARTESiA. J Am Coll Cardiol. Published 19 May 2024. doi:10.
Summarised from the published abstract; every number is checked against it