Apixaban vs Aspirin According to CHA<sub>2</sub>DS<sub>2</sub>-VASc Score in Subclinical Atrial Fibrillation: Insights From ARTESiA.
case_series · Level IV
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- Record sourced from PubMed, PMID 39019530.
- Also identified by DOI 10.1016/j.jacc.2024.05.002.
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Abstract
ARTESiA (Apixaban for the Reduction of Thrombo-Embolism in Patients With Device-Detected Sub-Clinical Atrial Fibrillation) demonstrated that apixaban, compared with aspirin, significantly reduced stroke and systemic embolism (SE) but increased major bleeding in patients with subclinical atrial fibrillation. To help inform decision making, the authors evaluated the efficacy and safety of apixaban according to baseline CHA<sub>2</sub>DS<sub>2</sub>-VASc score. We performed a subgroup analysis according to baseline CHA<sub>2</sub>DS<sub>2</sub>-VASc score and assessed both the relative and absolute differences in stroke/SE and major bleeding. Baseline CHA<sub>2</sub>DS<sub>2</sub>-VASc scores were <4 in 1,578 (39.4%) patients, 4 in 1,349 (33.6%), and >4 in 1,085 (27.0%). For patients with CHA<sub>2</sub>DS<sub>2</sub>-VASc >4, the rate of stroke was 0.98%/year with apixaban and 2.25%/year with aspirin; compared with aspirin, apixaban prevented 1.28 (95% CI: 0.43-2.12) strokes/SE per 100 patient-years and caused 0.68 (95% CI: -0.23 to 1.57) major bleeds. For CHA<sub>2</sub>DS<sub>2</sub>-VASc <4, the stroke/SE rate was 0.85%/year with apixaban and 0.97%/year with aspirin. Apixaban prevented 0.12 (95% CI: -0.38 to 0.62) strokes/SE per 100 patient-years and caused 0.33 (95% CI: -0.27 to 0.92) major bleeds. For patients with CHA<sub>2</sub>DS<sub>2</sub>-VASc =4, apixaban prevented 0.32 (95% CI: -0.16 to 0.79) strokes/SE per 100 patient-years and caused 0.28 (95% CI: -0.30 to 0.86) major bleeds. One in 4 patients in ARTESiA with subclinical atrial fibrillation had a CHA<sub>2</sub>DS<sub>2</sub>-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 CHA<sub>2</sub>DS<sub>2</sub>-VASc score <4. A substantial intermediate group (CHA<sub>2</sub>DS<sub>2</sub>-VASc =4) exists in which patient preferences will inform treatment decisions. (Apixaban for the Reduction of Thrombo-Embolism in Patients With Device-Detected Sub-Clinical Atrial Fibrillation; NCT01938248).
Medical subject headings
- Atrial Fibrillation
- Pyrazoles
- Pyridones
- Aspirin
- Stroke
- Factor Xa Inhibitors