Arrhythmias & electrophysiologyMeta-analysis
Direct Oral Anticoagulants for Stroke Prevention in Patients With Device-Detected Atrial Fibrillation: A Study-Level Meta-Analysis of the NOAH-AFNET 6 and ARTESiA Trials
- Systematic review and meta-analysis of randomised trials
- random-effects
- GRADE
- preregistered
Authors' conclusion
Meta-analysis of these 2 large randomized trials provides high-quality evidence that oral anticoagulation with edoxaban or apixaban reduces the risk of stroke in patients with device-detected atrial fibrillation and increases the risk of major bleeding.
Study context
- Population
- Adults with device-detected AF recorded by a pacemaker, ICD, CRT device or implanted cardiac monitor2 RCTs
- Comparison
- OAC vs antiplatelet or no antithrombotic therapy
- Outcome
- Ischemic stroke
Pooled result
As reported in the abstract
Relative risk
0.68
95% CI 0.50–0.92
OAC vs Antiplatelet or no antithrombotic therapy
RR 0.68 (95% CI 0.50–0.92)
Further pooled results
| Outcome | RR (95% CI) | |
|---|---|---|
| Composite of CV death, all-cause stroke, peripheral arterial embolism, MI or PE · I2=0%; moderate-quality evidence | 0.85 (0.73–0.99) | |
| 0.512Relative risk (log scale) |
CV death
- No reduction in CV death
All-cause mortality
- No reduction in all-cause mortality
Safety
| Outcome | RR (95% CI) | |
|---|---|---|
| Major bleeding · I²=61%; high-quality evidence | 1.62 (1.05–2.50) | |
| 0.512Relative risk (log scale) |
Parts of this Brief are withheld: the automatic checks could not confirm them against the abstract.
Original publication
Direct Oral Anticoagulants for Stroke Prevention in Patients With Device-Detected Atrial Fibrillation: A Study-Level Meta-Analysis of the NOAH-AFNET 6 and ARTESiA Trials. Circulation. Published 12 November 2023. doi:10.1161/circulationaha.123.067512
Summarised from the published abstract; every number is checked against it