Arrhythmias & electrophysiologySecondary analysis
Apixaban vs Aspirin According to CHA2DS2-VASc Score in Subclinical Atrial Fibrillation
- Subgroup analysis of the ARTESiA randomised trial
- subgroup analysis by baseline CHA2DS2-VASc score
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
Primary result
As reported in the abstract
Stroke/SE by CHA2DS2-VASc score
Apixaban
0.98%/year
Stroke, CHA2DS2-VASc >4 · Stroke/SE, CHA2DS2-VASc <4 0.85%/year
Aspirin
2.25%/year
Stroke, CHA2DS2-VASc >4 · Stroke/SE, CHA2DS2-VASc <4 0.97%/year
strokes/SE prevented, per 100 patient-years
- CHA2DS2-VASc >4
- 1.28 (95% CI 0.43–2.12)
- CHA2DS2-VASc =4
- 0.32 (95% CI −0.16 to 0.79)
- CHA2DS2-VASc <4
- 0.12 (95% CI −0.38 to 0.62)
Safety
| Outcome | major bleeds caused (per 100 patient-years) (95% CI) |
|---|---|
| Major bleeding by CHA2DS2-VASc score — Apixaban vs Aspirin · CHA2DS2-VASc >4 | 0.68 (−0.23 to 1.57) |
| Major bleeding by CHA2DS2-VASc score — Apixaban vs Aspirin · CHA2DS2-VASc =4 | 0.28 (−0.30 to 0.86) |
| Major bleeding by CHA2DS2-VASc score — Apixaban 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. J Am Coll Cardiol. Published 19 May 2024. doi:10.1016/j.jacc.2024.05.002
Summarised from the published abstract; every number is checked against it