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Anticoagulation in patients with atrial high-rate episodes

The risk of stroke in patients with atrial high-rate episodes (AHREs) depends on age, comorbidities and AHRE burden. Two randomized clinical trials on the use of oral anticoagulant therapy for stroke prevention in older patients with short and rare AHREs have reported conflicting findings on the efficacy of oral anticoagulation in this patient population, although both trials report a significantly increased risk of major bleeding with oral anticoagulation.

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Fig. 1: Randomized clinical trials on oral anticoagulation for stroke prevention in patients with AHREs.

References

  1. Hindricks, G. et al. 2020 ESC guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): the task force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur. Heart J. 42, 373–498 (2021).

    Article  PubMed  Google Scholar 

  2. Ruff, C. T. et al. Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials. Lancet 383, 955–962 (2014).

    Article  CAS  PubMed  Google Scholar 

  3. Freedman, B. et al. Management of atrial high-rate episodes detected by cardiac implanted electronic devices. Nat. Rev. Cardiol. 14, 701–714 (2017).

    Article  PubMed  Google Scholar 

  4. Lip, G. Y. H. et al. Atrial fibrillation and stroke prevention: 25 years of research at EP Europace journal. Europace 25, euad226 (2023).

    Article  PubMed  PubMed Central  Google Scholar 

  5. Vitolo, M. et al. Device-detected atrial high rate episodes and the risk of stroke/thrombo-embolism and atrial fibrillation incidence: a systematic review and meta-analysis. Eur. J. Intern. Med. 92, 100–106 (2021).

    Article  PubMed  Google Scholar 

  6. Healey, J. S. et al. Subclinical atrial fibrillation and the risk of stroke. N. Engl. J. Med. 366, 120–129 (2012).

    Article  CAS  PubMed  Google Scholar 

  7. Singer, D. E., Ziegler, P. D., Koehler, J. L., Sarkar, S. & Passman, R. S. Temporal association between episodes of atrial fibrillation and risk of ischemic stroke. JAMA Cardiol. 6, 1364–1369 (2021).

    Article  PubMed  PubMed Central  Google Scholar 

  8. Kirchhof, P. et al. Anticoagulation with edoxaban in patients with atrial high-rate episodes. N. Engl. J. Med. 389, 1167–1179 (2023).

    Article  CAS  PubMed  Google Scholar 

  9. Healey, J. S. et al. Apixaban for stroke prevention in subclinical atrial fibrillation. N. Engl. J. Med. https://doi.org/10.1056/NEJMoa2310234 (2023).

  10. Van Gelder, I. C. et al. Duration of device-detected subclinical atrial fibrillation and occurrence of stroke in ASSERT. Eur. Heart J. 38, 1339–1344 (2017).

    Article  PubMed  Google Scholar 

  11. Becher, N. et al. Anticoagulation with edoxaban in patients with long atrial high-rate episodes ≥24 hours. Eur. Heart J. https://doi.org/10.1093/eurheartj/ehad771 (2023).

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Correspondence to Tatjana Potpara.

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Potpara, T., Blomstrom-Lundqvist, C. Anticoagulation in patients with atrial high-rate episodes. Nat Rev Cardiol 21, 5–6 (2024). https://doi.org/10.1038/s41569-023-00963-2

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